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. 2021 Apr;34(2):608-620.
doi: 10.1007/s12028-020-01015-0.

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Katharina M Busl  1 , Ariane Lewis  2 , Panayiotis N Varelas  3
Affiliations

Apnea Testing for the Determination of Brain Death: A Systematic Scoping Review

Katharina M Busl et al. Neurocrit Care. 2021 Apr.

Abstract

Apnea is one of the three cardinal findings in brain death (BD). Apnea testing (AT) is physiologically and practically complex. We sought to review described modifications of AT, safety and complication rates, monitoring techniques, performance of AT on extracorporeal membrane oxygenation (ECMO), and other relevant considerations regarding AT. We conducted a systematic scoping review to answer these questions by searching the literature on AT in English language available in PubMed or EMBASE since 1980. Pediatric or animal studies were excluded. A total of 87 articles matched our inclusion criteria and were qualitatively synthesized in this review. A large body of the literature on AT since its inception addresses a variety of modifications, monitoring techniques, complication rates, ways to perform AT on ECMO, and other considerations such as variability in protocols, lack of uniform awareness, and legal considerations. Only some modifications are widely used, especially methods to maintain oxygenation, and most are not standardized or endorsed by brain death guidelines. Future updates to AT protocols and strive for unification of such protocols are desirable.

Keywords: Apnea; Apnea test; Apnoea; Apnoea test; Brain death.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Standard Apnea Test with Oxygen Insufflation according to the guidelines of the American Academy of Neurology [4]
Fig. 2
Fig. 2
Flow diagram of record identification, screening, eligibility and inclusion
See this image and copyright information in PMC

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