Tension pneumothorax complicating apnea testing during brain death evaluation

Tension pneumothorax is a rare complication of the apnea test using the apneic oxygenation method. In reported cases, it has been attributed to massive air trapping beyond a supplemental oxygen cannula that was obstructing the airway. We report a case of tension pneumothorax, pneumomediastinum, and pneumoperitoneum that developed during the apnea test as a result of direct airway perforation by the supplemental oxygen cannula. We review the literature concerning catastrophic airway complications associated with the apneic oxygenation method and suggest ways to avoid them. (C) 2007 Elsevier Ltd. All rights reserved.