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2017 ; 5
(ä): 2050313X17716050
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Prolonged duration of apnea test during brain death examination in a case of
intraparenchymal hemorrhage
#MMPMID28680635
Nattanmai P
; Newey CR
; Singh I
; Premkumar K
SAGE Open Med Case Rep
2017[]; 5
(ä): 2050313X17716050
PMID28680635
show ga
OBJECTIVE: Apnea test is required as part of the brain death examination. The
duration of the apnea test is variable but typically requires 8-10?min. Prolonged
apnea tests have been reported in the setting of hypothermia. Here, we describe a
case of prolonged duration of apnea test secondary to a phenomenon called cardiac
ventilation. METHODS: The patient presented in coma with brainstem areflexia
after having an intracerebral hemorrhage resulting in subfalcine, central, uncal,
and tonsillar herniations. Confounding variables were excluded. Brain death
testing was performed, and she was found to have brainstem areflexia.
Pre-requisites for apnea test were then met. RESULTS: Apnea testing, however, was
prolonged at 110?min. When reconnected to ventilator, it was noted that she had
small (30-35?cc) tidal volumes at a rate of her heart rate without respiratory
effort. Ancillary testing with four-vessel cerebral angiogram confirmed cerebral
circulatory arrest. CONCLUSIONS: To our knowledge, this is the longest reported
case of apnea testing during brain death testing. Variables known to cause a
delay in the rise of carbon dioxide (PaCO(2)) levels were excluded. We suspect
the hyperdynamic cardiac state caused cardiac ventilations resulting in slow
increase in carbon dioxide levels.