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The use of extracorporeal membrane oxygenation (ECMO) in adult patients continues to increase. Suspicion of brain death while on ECMO creates a conundrum. The American Academy of Neurology states that apnea testing is a critical component of the process to declare brain death. However, there is a paucity of literature on apnea testing for confirmation of brain death in patients on venoarterial ECMO and venovenous ECMO. Traditional apnea testing does not consider ECMO physiology or de-recruitment of the lungs in this subset of critically ill patients. Complications with traditional apnea testing include hemodynamic instability that may lead to cardiac arrest and death.

Carbogen for Apnea Testing During the Brain Death Declaration Process in Subjects on Extracorporeal Membrane Oxygenation