| Autor: |
Taran S; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. Shaurya.taran@mail.utoronto.ca.; Interdepartmental Division of Critical Care, Li Ka Shing Knowledge Institute, University of Toronto, 204 Victoria Street, 4th Floor, Room 411, Toronto, ON, M5B 1T8, Canada. Shaurya.taran@mail.utoronto.ca., Steel A; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Anaesthesiology, University Health Network, Toronto, ON, Canada.; Trillium Gift of Life Network, Toronto, ON, Canada., Healey A; Department of Medicine, McMaster University, Hamilton, ON, Canada.; Trillium Gift of Life Network, Toronto, ON, Canada., Fan E; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University Health Network, Toronto, ON, Canada.; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada., Singh JM; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Department of Medicine, University Health Network, Toronto, ON, Canada.; Trillium Gift of Life Network, Toronto, ON, Canada. |
| Abstrakt: |
The use of extracorporeal membrane oxygenation (ECMO) is increasing globally, although mortality in this setting remains high. Patients on ECMO may be potential organ donors in the context of withdrawal of life-sustaining measures (WLSM) or neurologic determination of death (NDD). Nevertheless, there are currently no Canadian standards to guide clinicians on NDD or WLSM for the purposes of organ donation in this patient population. Apnea testing remains fundamental to determining NDD and is an area where ECMO may alter routine procedures. In this review, we outline protocols for the performance of apnea testing and WLSM for patients supported with ECMO, highlighting important technical and physiologic considerations that may affect the determination of death. In addition, we review important considerations for NDD in ECMO, including management of potential confounders, strategies for controlling oxygen and carbon dioxide levels during apnea testing, and the appropriate use of ancillary tests to support NDD. In the context of ECMO support, there is limited evidence to guide NDD and WLSM for the purposes of organ donation. Drawing upon extensive clinical experience, we provide protocols for these processes and review other important considerations in an effort to maximize donor potential in this growing patient population. |
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