Journal List > J Korean Soc Transplant > v.31(1) > 1034531

Jee, Cha, and Kim: Reduction of Apnea Test Time in an Extracorporeal Membrane Oxygenation-Dependent Potential Donor


The diagnosis of brain death is essential for deceased donor organ transplantation. Currently, extracorporeal membrane oxygenation (ECMO) is used to increase the chance of survival of patients with severe cardiac and respiratory failure. Therefore, cases of ECMO-dependent potential donors are increasing. The apnea test (AT) is a mandatory component in the clinical determination of brain death. However, conventional AT is not easily applicable to ECMO-dependent potential donors because both the ventilator and ECMO play an important role in carbon dioxide elimination. Accordingly, different methods of AT from those used in routine procedures must be considered. We report here a case of conventional AT with time delay and two cases of AT within 3 minutes by adjusting sweep gas flow rate of ECMO in ECMO-dependent potential donors.


1). Scott JB., Gentile MA., Bennett SN., Couture M., MacIntyre NR. Apnea testing during brain death assessment: a review of clinical practice and published literature. Respir Care. 2013. 58:532–8.
2). Lang CJ., Heckmann JG. Apnea testing for the diagnosis of brain death. Acta Neurol Scand. 2005. 112:358–69.
3). Lovrencic-Huzjan A. Transcranial Doppler as an confirmatory test in brain death. Randhawa G, editor. Organ donation and transplantation: public policy and clinical perspectives. Rijeka: Intech;2012. 267-84. Available from:.
4). Gattinoni L., Carlesso E., Langer T. Clinical review: extracorporeal membrane oxygenation. Crit Care. 2011. 15:243.
5). Chung M., Shiloh AL., Carlese A. Monitoring of the adult patient on venoarterial extracorporeal membrane oxygenation. ScientificWorldJournal. 2014. 2014:393258.
6). Kim EY., Kim JH. Predisposing hemodynamic factors associated with a failed apnea test during brain death determination. Korean J Crit Care Med. 2016. 31:236–42.

Table 1.
Vital sign and PaO2 during apnea test
Variable Case 1 Case 2 Case 3
Mean blood pressure (mmHg)
  Primary apnea test 78→60 80→77 94→87
  Secondary apnea test 96→101 77→64 86→96
Heart rate (beat/min)
  Primary apnea test 101→101 115→115 99→97
  Secondary apnea test 101→101 101→104 97→96
PaO2 (mmHg)
  Primary apnea test 213.0→137.5 134.2→87.5 491.0→344.5
  Secondary apnea test 383.7→629.0 232.9→285.3 256.6→380.9

Abbreviation: PaO2, partial pressure of arterial oxygen.

Similar articles