scholarly journals The effect of incorporating an arterial pH target during apnea test for brain death determination

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ibrahim Migdady ◽  
Moein Amin ◽  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-Min Cho ◽  
...  
Keyword(s):  
Brain Death ◽  
Cleveland Clinic ◽  
Apnea Test ◽  
Arterial Ph ◽  
Common Etiology ◽  
Brain Death Determination ◽  
Blood Gas Analyses ◽  
The Impact ◽  
Death Determination ◽  
Current Guidelines

Abstract Background Persistent apnea despite an adequate rise in arterial pressure of CO2 is an essential component of the criteria for brain death (BD) determination. Current guidelines vary regarding the utility of arterial pH changes during the apnea test (AT). We aimed to study the effect of incorporating an arterial pH target < 7.30 during the AT (in addition to the existing PaCO2 threshold) on brain death declarations. Methods We performed retrospective analysis of consecutive adult patients who were diagnosed with BD and underwent AT at the Cleveland Clinic over the last 10 years. Data regarding baseline and post-AT blood gas analyses were collected and analyzed. Results Ninety-eight patients underwent AT in the study period, which was positive in 89 (91%) and inconclusive in 9 (9%) patients. The mean age was 50 years old (standard deviation [SD] 16) and 54 (55%) were female. The most common etiology BD was hypoxic ischemic brain injury (HIBI) due to cardiac arrest (42%). Compared to those with positive AT, patients with inconclusive AT had a higher post-AT pH (7.24 vs 7.17, p = 0.01), lower PaO2 (47 vs 145, p < 0.01), and a lower PaCO2 (55 vs 73, p = 0.01). Among patients with a positive AT using PaCO2 threshold alone, the frequency of patients with post-AT pH < 7.30 was 95% (83/87). Conclusion Implementing a BD criteria requiring both arterial pH and PaCO2 thresholds reduced the total number of positive ATs; these inconclusive cases would have required longer duration of AT to reach both targets, repeated ATs, or ancillary studies to confirm BD. The impact of this on the overall number BD declarations requires further research.

744: Sensitivity of Arterial pH Changes During Apnea Test for Brain Death Determination

2020 ◽  
Vol 49 (1) ◽  
pp. 368-368
Author(s):  
Ibrahim Migdady ◽  
Moein Amin ◽  
Aaron Shoskes ◽  
Catherine Hassett ◽  
Sung-Min Cho ◽  
...  
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Ph Changes ◽  
Arterial Ph ◽  
Brain Death Determination ◽  
Death Determination

Brain Death, Organ Donation, and Transplantation

2018 ◽  
pp. 276-285
Author(s):  
Hilary H. Wang ◽  
David M. Greer
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
The United States ◽  
Apnea Test ◽  
Unit Management ◽  
Legal Context ◽  
History Of ◽  
Brain Death Determination ◽  
Brain Dead ◽  
Death Determination

This chapter reviews the history of brain death determination, current guidelines for performing the brain death examination including the apnea test, details of apnea testing, the role of brain dead donors in organ donation, physiologic changes seen in brain dead patients, and the relevant challenges in intensive care unit management of such patients for donor organ optimization. The goal of this chapter is to provide clear guidance for a critical care provider to perform an accurate and thorough brain death examination and to further the reader’s understanding of the historical and legal context surrounding brain death and organ donation in the United States.

scholarly journals Variability Across Countries for Brain Death Determination in Adults

2020 ◽  
Author(s):  
Fang Yuan ◽  
Weijun Zhang ◽  
Wanxin Wen ◽  
Huiping Li ◽  
Shibiao Wu ◽  
...  
Keyword(s):  
Brain Death ◽  
Predictive Value ◽  
Diagnostic Procedures ◽  
Apnea Test ◽  
Ancillary Test ◽  
Brain Death Determination ◽  
Technical Specifications ◽  
Sensitivity Specificity ◽  
Death Determination ◽  
Prospective Database

Abstract Background: Currently there is variability in diagnostic procedures across countries. Our aim was to compare guidelines of brain death determination in adults among five countries: China, UK, US, France, and Germany.Method: This is a retrospective study based on a prospective database of consecutive coma patients who received brain death determination. The technical specifications, completion rates, and positive rates of brain death determination according to criteria of different countries were compared. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each ancillary test for the identification of brain death diagnosed according to different criteria were investigated.Results: One hundred and ninety-nine patients who received brain death determination from June 2018 to June 2020 were included in this study. One hundred and thirty-one (65.8%) patients were diagnosed with brain death according to French criteria, 132 (66.3%) according to Chinese criteria, and 135 (67.7%) according to criteria of US, UK, and Germany. The sensitivity and PPV of EEG (92.2% - 92.3%) and SLSEP (95.5% - 98.5%) were higher than TCD (84.3% - 86.0%), and all these three tests have a very low specificity and NPV.Conclusions: The duration of apnea test and requirements of ancillary tests vary among countries. The discrepancy in brain death determination between clinical assessments and additional confirmation of ancillary tests is small.

Use of Ancillary Tests When Determining Brain Death in Pediatric Patients in the United States

2017 ◽  
Vol 32 (12) ◽  
pp. 975-980 ◽  
Author(s):  
Ariane Lewis ◽  
Nellie Adams ◽  
Arun Chopra ◽  
Matthew P. Kirschen
Keyword(s):  
United States ◽  
Brain Death ◽  
The United States ◽  
Apnea Test ◽  
Ancillary Test ◽  
Regulatory Bodies ◽  
Brain Death Determination ◽  
Death Determination ◽  
Pediatric Brain ◽  
The Brain

Although pediatric brain death guidelines stipulate when ancillary testing should be used during brain death determination, little is known about the way these recommendations are implemented in clinical practice. We conducted a survey of pediatric intensivists and neurologists in the United States on the use of ancillary testing. Although most respondents noted they only performed an ancillary test if the clinical examination and apnea test could not be completed, 20% of 195 respondents performed an ancillary test for other reasons, including (1) to convince a family that objected to the brain death determination that a patient is truly dead (n = 21), (2) personal preference (n = 14), and (3) institutional requirement (n = 5). Our findings suggest that pediatricians use ancillary tests for a variety of reasons during brain death determination. Medical societies and governmental regulatory bodies must reinforce the need for homogeneity in practice.

Predictors of Apnea Test Failure During Brain Death Determination

2010 ◽  
Vol 12 (3) ◽  
pp. 352-355 ◽  
Author(s):  
Alan H. Yee ◽  
Jay Mandrekar ◽  
Alejandro A. Rabinstein ◽  
Eelco FM Wijdicks
Keyword(s):  
Brain Death ◽  
Apnea Test ◽  
Brain Death Determination ◽  
Death Determination ◽  
Test Failure

The apnea test in brain death determination using oxygen diffusion method remains safe

Neurology ◽  
2019 ◽  
Vol 92 (8) ◽  
pp. 386-387 ◽  
Author(s):  
Ali Daneshmand ◽  
Alejandro A. Rabinstein ◽  
Eelco F.M. Wijdicks
Keyword(s):  
Brain Death ◽  
Oxygen Diffusion ◽  
Diffusion Method ◽  
Apnea Test ◽  
Brain Death Determination ◽  
Death Determination
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