The apnea test for brain death determination - An alternative approach

Introduction: Problems associated with the standard apnea test relate to overshooting or undershooting the target PaCO2, potentially compromising the viability of organs for transplantation or invalidating the test. Materials and Methods: In 60 adult patients, the authors used an alternative method using exogenously administered CO2 and measurement of end-tidal CO2. Results: All patients achieved an adequate respiratory stimulus (mean increase in PaCO2 was 28 +/- 3 mmHg, postapnea test pH was 7.20 +/- .02). There was a clinically insignificant reduction in arterial blood pressure during testing, but no other complications occurred. Multiple regression analysis demonstrated a correlation between the predicted PaCO2 (predicted from the end-tidal CO2) and measured PaCO2 (64 +/- 9 versus 67 +/- 9; r =.75169, P < 0.0001). Conclusion: Exogenously administered CO2 as an alternative method for the standard apnea test was a reliable and safe method, with minimal complications that offers several advantages over the standard method.