The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

THE APNEA TEST FOR BRAIN DEATH WHILE STILL VENTILATED: IS IT FEASIBLE?

Mary Ann Couture1, Rogers Pylant1, Judith Pepe2; 1Respiratory Therapy, Hartford Hospital, Hartford, CT; 2Surgery, Hartford Hospital, Hartford, CT

BACKGROUND: Apnea testing is one of the last of a series of clinical tests for the diagnosis brain death. Because of the length of time that a patient is disconnected from a ventilator, there are high incidence reports of complications that could compromise viability of organs destined for transplantation primarily due to hypoxemia or cardiovascular instability. METHODS: As part of a quality-improvement project of the apnea test procedure, we assessed a formula that predicts target PaCO2 and PaCO2 using a gas mix of 3% carbon dioxide/97% oxygen(carbogen)with capnography while patients remained on the ventilator, some who had high PEEP levels. This is a follow up to a previous pilot study to test the calculated formula. We, also conducted a retrospective review of 60 sequential patients from January 2006 through December 2008, from which we compared the frequency of complications in literature review since the 1995 American Academy of Neurology evidence-based practice guidelines were published. RESULTS: Multiple regression analysis of the formula showed a significant relationship between predicted PaCO2 and post test PaCO2, r =.83, r2 = .68 p < .089. Eight studies that either used the practice guidelines or variations of the apnea test, and reported on complications were found. Comparisons from carbogen vs. 1995 guidelines, respectively showed 12 % vs. 14% incidence of hypotension, and < 1% vs. 7% incidence of hypoxemia, were our major findings. We had no incidence of asystole or arrhythmia, which were reported in the literature. CONCLUSION: Carbogen administration is a safe alternative to the current apnea test guideline and allows for patients to be tested in the presence of severe lung injury. Sponsored Research - None