The Physiology of the Apnea Test for Brain Death Determination in ECMO: Arguments for Blending Carbon Dioxide

NCJ_cover.jpgBy William B. Beam, Phillip D. Scott, Eelco F. M. Wijdicks

First Online: 08 August 2019

Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support which can be utilized as a rescue modality in patients with treatment refractory cardiac or respiratory failure. ECMO removes deoxygenated blood from the venous circulation via large bore cannula where it is pumped through a membrane oxygenator which adds oxygen (O2) and removes carbon dioxide (CO2). The blood is then returned back to the circulation. Depending on the type of organ failure, the oxygenated blood can be returned to the venous circulation or the arterial circulation (VA ECMO). The patient’s underlying physiologic derangement ultimately determines the type of ECMO [1].

ECMO is becoming an increasingly common supportive modality. From 1998 to 2015, the Extracorporeal Life Support Organization collected data on 65,171 patients undergoing support with ECMO with 53% neonates, 25% pediatric, and 23% adults. The indications for ECMO were respiratory failure (63%), cardiac failure...

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