- Neurology
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Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
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Eun Young Kim, Ji Hyun Kim
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Korean J Crit Care Med. 2016;31(3):236-242. Published online August 30, 2016
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DOI: https://doi.org/10.4266/kjccm.2016.00332
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 Abstract
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- Background
The apnea test is an essential component in the clinical determination of brain death, however it may incur a significant risk of complications such as hypotension, hypoxia and even cardiac arrest. We analyzed the risk factors associated with a failed apnea test during brain death assessment in order to predict and avoid these adverse events.
Methods
Medical records on apnea tests performed for brain-dead donors at our institution between January 2009 and January 2016 were retrospectively reviewed. Age, gender, etiology of brain death, use of catecholamines and results of arterial blood gas analysis (ABGA), systolic/diastolic blood pressure (SBP/DBP), mean arterial pressure and central venous pressure prior to apnea test initiation were collected as variables. A-a gradient and PaO2/FiO2 were calculated for more precise assessment of the respiratory system. In total, 267 cases were divided into two groups based on those who completed the apnea test and those who failed the test.
Results
13 cases failed the apnea test. Among them, seven cases failed due to severe hypotension (SBP < 60 mmHg) and the others failed due to refractory hypoxia. In terms of hemodynamic state, SBP was significantly higher in the completed test group than the failed group (126.5 ± 23.9 vs. 103 ± 15.2, respectively; p = 0.001). In ABGA, the completed test group showed significantly higher PaO2/ FiO2 (313.6 ± 229.8 vs. 141.5 ± 131.0, respectively; p = 0.008) and a lower A-a gradient (278.2 ± 209.5 vs. 506.2 ± 173.1, respectively; p = 0.000). In multivariable analysis, low SBP (p = 0.003) and high A-a gradient (p = 0.044) were independent risk factors associated with a failed apnea test.
Conclusions
Although the unexpected adverse events during the apnea test for brain death determination do not occur frequently, they can be fatal. If a brain-dead patient has low SBP and a high A-a gradient, clinicians should pay more attention and prepare for potential complications prior to the apnea test.
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Citations
Citations to this article as recorded by  - Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination
Jin Joo Kim, Eun Young Kim
Transplantation Proceedings.2019; 51(6): 1655. CrossRef - Reduction of Apnea Test Time in an Extracorporeal Membrane Oxygenation-Dependent Potential Donor
Hyeon Sook Jee, Sora Cha, Gaab Soo Kim
Korean Journal of Transplantation.2017; 31(1): 49. CrossRef
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