Safety and reliability of artificial CO2 augmentation method in comparison with standard apneic oxygenation method for brain death determination

Salman Farooq; John T Roddy; Vijay Johnson

doi:10.1016/j.clineuro.2022.107219

Safety and reliability of artificial CO2 augmentation method in comparison with standard apneic oxygenation method for brain death determination

Clin Neurol Neurosurg. 2022 May:216:107219. doi: 10.1016/j.clineuro.2022.107219. Epub 2022 Mar 26.

Authors

Salman Farooq¹, John T Roddy², Vijay Johnson³

Affiliations

¹ Assistant Professor of Neurology, Department of Neurology, Division of Inpatient Neurology, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: [email protected].
² Fellow, Department of Medicine, Division of Pulmonary & Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA.
³ Assistant Professor of Neurology, Department of Neurology, Division of Inpatient Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

PMID: 35398792
DOI: 10.1016/j.clineuro.2022.107219

Abstract

Introduction: The most commonly used apnea test for determination of brain death is the apneic oxygenation method. While all the commonly used apnea tests have associated complications, artificial CO₂ augmentation has been reported to have fewer complications. However, data supporting the use of the latter method is limited.

Methods: We identified 102 patients who underwent brain death testing during the last ten years. Artificial CO₂ augmentation apnea testing was used in 50 of these patients while 52 patients underwent standard apneic oxygenation apnea testing.

Results: No significant differences between the two groups were noted in any previously considered clinical outcomes, including hypoxemia, acidemia, or shock. However, shorter duration of apnea testing was observed in the artificial CO₂ augmentation method suggesting its feasibility to the standard apneic oxygenation method in terms of convenience and reduction of the risk surrounding prolonged hypercapnia and hypoxemia.

Conclusion: This retrospective cohort study provides further observational evidence to support the safety of alternate apnea testing techniques with the standard apnea method for determination of brain death in adults.