ReviewRevista Brasileira de terapia intensiva2020
Apnea test for brain death diagnosis in adults on extracorporeal membrane oxygenation: a review.
Review in Revista Brasileira de terapia intensiva, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
7 citing papers in PubMed, 15 citations in OpenAlex.
- Neuroprognostication After Extracorporeal Cardiopulmonary Resuscitation: ECMO-Specific Challenges and a Multimodal Time-Sensitive Framework.Journal of cardiovascular development and disease · 2026Review
- Organ donation from extracorporeal membrane oxygenation and ventricular assist devices in Victoria, Australia: Characteristics and trends.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Diagnosis of brain death and consecutive donor management under combined circulatory support with ECMELLA therapy.Frontiers in medicine · 2025Article
- Apnea testing for brain death confirmation in VV-ECMO patients with very low sweep flow: a case reports and practical physiological insights.Critical care science · 2025Article
- Challenges in determining death by neurologic criteria in extracorporeal membrane oxygenation - A single center experience.Perfusion · 2024Observational
- [Determination of brain death in patients on extracorporeal membrane oxygenation-case report].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2023Article
- Apnea Test on Extracorporeal Membrane Oxygenation: Step Forward with Carbon Dioxide.The journal of extra-corporeal technology · 2022Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Among the potential complications of extracorporeal membrane oxygenation, neurological dysfunctions, including brain death, are not negligible. In Brazil, the diagnostic process of brain death is regulated by Federal Council of Medicine resolution 2,173 of 2017. Diagnostic tests for brain death include the apnea test, which assesses the presence of a ventilatory response to hypercapnic stimulus. However, gas exchange, including carbon dioxide removal, is maintained under extracorporeal membrane oxygenation, making the test challenging. In addition to the fact that the aforementioned resolution does not consider the specificities of the diagnostic process under extracorporeal membrane oxygenation, studies on the subject are scarce. This review aims to identify case studies (and/or case series) published in the PubMed® and Cochrane databases describing the process of brain death diagnosis. A total of 17 publications (2011 - 2019) were identified. The practical strategies described were to provide pretest supplemental oxygenation via mechanical ventilation and extracorporeal membrane oxygenation (fraction of inspired oxygen = 1.0) and, at the beginning of the test, titrate the sweep flow (0.5 - 1.0L/minute) to minimize carbon dioxide removal. It is also recommended to increase blood flow and/or sweep flow in the presence of hypoxemia and/or hypotension, which may be combined with fluid infusion and/or the escalation of inotropic/vasoactive drugs. If the partial pressure of carbon dioxide threshold is not reached, repeating the test under supplementation of carbon dioxide exogenous to the circuit is an alternative. Last, in cases of venoarterial extracorporeal membrane oxygenation, to measure gas variation and exclude differential hypoxia, blood samples of the native and extracorporeal (post-oxygenator) circulations are recommended.
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Registered trials
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