ArticleIntensive care medicine2016
Apnea test during brain death assessment in mechanically ventilated and ECMO patients.
Article in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 72 citations in OpenAlex.
- Guideline
- Understanding the "extracorporeal membrane oxygenation gap" in veno-arterial configuration for adult patients: Timing and causes of death.Artificial organs · 2021Pooled it
- Prospective Evaluation of a Modified Apnea Test in Brain Death Candidates that Does Not Require Disconnection from the Ventilator.Neurocritical care · 2024Observational
- Apnea Testing on Conventional Mechanical Ventilation During Brain Death Evaluation.Neurocritical care · 2024Observational
- Challenges in determining death by neurologic criteria in extracorporeal membrane oxygenation - A single center experience.Perfusion · 2024Observational
- New developments in guidelines for brain death/death by neurological criteria.Nature reviews. Neurology · 2024Review
- [Determination of brain death in patients on extracorporeal membrane oxygenation-case report].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2023Article
- Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death.Critical care explorations · 2022Article
- Apnea Test on Extracorporeal Membrane Oxygenation: Step Forward with Carbon Dioxide.The journal of extra-corporeal technology · 2022Article
- [Irreversible loss of brain function : Requirements and Clinical diagnosis].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2021Article
- Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review.Neurocritical care · 2021Article
- Strategies for hemodynamic maintenance of potential brain-dead donor: integrative review.Einstein (Sao Paulo, Brazil) · 2021Review
- Modifiable Risk Factors and Mortality From Ischemic and Hemorrhagic Strokes in Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry.Critical care medicine · 2020Article
- Organ donation in patients on extracorporeal membrane oxygenation: considerations for determination of death and withdrawal of life support.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2020Review
- Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review.Revista Brasileira de terapia intensiva · 2020Review
- Joint Society of Critical Care Medicine-Extracorporeal Life Support Organization Task Force Position Paper on the Role of the Intensivist in the Initiation and Management of Extracorporeal Membrane Oxygenation.Critical care medicine · 2020Article
- Diagnosis of death using neurological criteria in adult patients on extracorporeal membrane oxygenation: Development of UK guidance.Journal of the Intensive Care Society · 2020Article
- The Challenges of Apnea Tests in the Determination of Brain Death in Child Patient on Extracorporeal Membrane Oxygenation.Frontiers in pediatrics · 2020Article
- The Influence of Therapeutics on Prognostication After Cardiac Arrest.Current treatment options in neurology · 2019Review
- Comparison of Two Apnea Test Methods, Oxygen Insufflation and Continuous Positive Airway Pressure During Diagnosis of Brain Death: Final Report.Neurocritical care · 2019Article
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate the feasibility and efficacy of an apnea test (AT) technique that combines the application of positive end expiratory pressure (PEEP) with subsequent pulmonary recruitment in a large cohort of brain-dead patients.
methodsThis study was a retrospective analysis of prospectively collected data on brain-dead patients admitted to our institution (Hospital San Gerardo, Monza, Italy) between January 2010 and December 2014. The rate of aborted apnea tests (ATs), occurrence of complications (i.e., pneumothorax, cardiac arrhythmias, cardiac arrest, and severe hypoxia, defined as PaO2 < 40 mmHg), ventilator settings, hemodynamics, and blood gas analyses were evaluated. Subgroup analysis was performed, with patients classified into veno-arterial extracorporeal membrane oxygenation (ECMO) or non-ECMO groups, and into hypoxic (i.e., baseline PaO2/FiO2 < 200 mmHg) and non-hypoxic (i.e., baseline PaO2/FiO2 > 200 mmHg) groups.
resultsIn total, 169 consecutive patients including 25 on ECMO were included in the study. No AT abortion nor severe complications were detected. The AT was completed in all patients. Fluid boluses and increases or initiation of vasoactive drugs were required in less than 10 and 3% of the AT procedures, respectively. No clinically meaningful alteration in hemodynamics was recorded. Severe hypoxia occurred during 7 (2.4%) and 4 (8%) of the ATs performed in non-ECMO and ECMO patients, respectively (p = 0.063), and it occurred more frequently in hypoxic patients than in non-hypoxic patients (11.1 vs. 4.8%, respectively; p = 0.002).
conclusionsIn a large cohort of consecutive patients, including the largest patient population on ECMO reported to date, our AT technique that combines the application of PEEP with subsequent pulmonary recruitment proved to be feasible and safe.
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