1Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC. 2Department of Pediatrics, Section of Pediatric Critical Care, Inova Fairfax Hospital for Children, Falls Church, VA. 3Department of Respiratory Care, Wake Forest Baptist Health, Brenner Children's Hospital, Winston-Salem, NC.
Pediatr Crit Care Med. 2014 Feb;15(2):e38-43. doi: 10.1097/PCC.0000000000000006.
The revised guidelines for the determination of brain death in infants and children stress that apnea testing is an integral component in determining brain death based on clinical criteria. Unfortunately, these guidelines provide no process for apnea testing during the determination of brain death in patients supported on venoarterial extracorporeal membrane oxygenation. We review three pediatric patients supported on venoarterial extracorporeal membrane oxygenation who underwent apnea testing during their brain death evaluation. This is the only published report to elucidate a reliable, successful method for apnea testing in pediatric patients supported on venoarterial extracorporeal membrane oxygenation.
Retrospective case series.
Two tertiary care PICUs in university teaching hospitals.
Three pediatric patients supported by venoarterial extracorporeal membrane oxygenation after cardiopulmonary arrest.
After neurologic examinations demonstrated cessation of brain function in accordance with current pediatric brain death guidelines, apnea testing was performed on each child while supported on venoarterial extracorporeal membrane oxygenation.
In two of the three cases, the patients remained hemodynamically stable with normal oxygen saturations as venoarterial extracorporeal membrane oxygenation sweep gas was weaned and apnea testing was undertaken. Apnea testing demonstrating no respiratory effort was successfully completed in these two cases. The third patient became hemodynamically unstable, invalidating the apnea test.
Apnea testing on venoarterial extracorporeal membrane oxygenation can be successfully undertaken in the evaluation of brain death. We provide a suggested protocol for apnea testing while on venoarterial extracorporeal membrane oxygenation that is consistent with the updated pediatric brain death guidelines. This is the only published report to elucidate a reliable, successful method for apnea testing in pediatric patients supported on venoarterial extracorporeal membrane oxygenation.
修订后的婴儿和儿童脑死亡判定指南强调，在基于临床标准判定脑死亡时，呼吸暂停试验是一个重要组成部分。不幸的是，这些指南并未为在接受静脉-动脉体外膜肺氧合支持的患者中判定脑死亡时的呼吸暂停试验提供流程。我们回顾了 3 例在接受脑死亡评估时接受静脉-动脉体外膜肺氧合支持的呼吸暂停试验的儿科患者。这是唯一一份阐明在接受静脉-动脉体外膜肺氧合支持的儿科患者中进行呼吸暂停试验的可靠、成功方法的已发表报告。
回顾性病例系列。
两所大学教学医院的三级儿童重症监护病房。
心肺骤停后接受静脉-动脉体外膜肺氧合支持的 3 例儿科患者。
在根据当前儿科脑死亡指南进行的神经检查显示脑功能停止后，对每个孩子在接受静脉-动脉体外膜肺氧合支持时进行呼吸暂停试验。
在这 3 例中的 2 例中，随着静脉-动脉体外膜肺氧合吹扫气体的减少，患者的血流动力学保持稳定，氧饱和度正常，完成了呼吸暂停试验。在这 2 例中，成功完成了无呼吸努力的呼吸暂停试验。第 3 例患者出现血流动力学不稳定，使呼吸暂停试验无效。
在脑死亡评估中，可以成功地在静脉-动脉体外膜肺氧合上进行呼吸暂停试验。我们提供了一种在静脉-动脉体外膜肺氧合时进行呼吸暂停试验的建议方案，该方案与更新的儿科脑死亡指南一致。这是唯一一份阐明在接受静脉-动脉体外膜肺氧合支持的儿科患者中进行呼吸暂停试验的可靠、成功方法的已发表报告。
