The Physiology of the Apnea Test for Brain Death Determination in ECMO: Arguments for Blending Carbon Dioxide

  • William B. BeamEmail author
  • Phillip D. Scott
  • Eelco F. M. Wijdicks
Practical Pearl


Extracorporeal membrane oxygenation (ECMO) is a form of extracorporeal life support which can be utilized as a rescue modality in patients with treatment refractory cardiac or respiratory failure. ECMO removes deoxygenated blood from the venous circulation via large bore cannula where it is pumped through a membrane oxygenator which adds oxygen (O2) and removes carbon dioxide (CO2). The blood is then returned back to the circulation. Depending on the type of organ failure, the oxygenated blood can be returned to the venous circulation or the arterial circulation (VA ECMO). The patient’s underlying physiologic derangement ultimately determines the type of ECMO [1].

ECMO is becoming an increasingly common supportive modality. From 1998 to 2015, the Extracorporeal Life Support Organization collected data on 65,171 patients undergoing support with ECMO with 53% neonates, 25% pediatric, and 23% adults. The indications for ECMO were respiratory failure (63%), cardiac failure...


Extracorporeal membrane oxygenation Extracorporeal life support ECMO Brain death Apnea test 


Author Contributions

WBB helped in the care of the patient in the case report and preparation of manuscript; PS helped in the care of the patient in the case report and preparation of manuscript; EW helped in the care of the patient in the case report and preparation of manuscript.

Source of Support

No funding source for this paper.

Conflicts of interest


Ethical approval/Informed consent

Upon admission the patient’s family consented to review of medical chart and extraction of information for research purposes.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2019

Authors and Affiliations

  1. 1.Division of Critical Care, Department of AnesthesiologyMayo ClinicRochesterUSA
  2. 2.Department of Cardiac SurgeryMayo ClinicRochesterUSA
  3. 3.Division of Neurocritical Care and Hospital Neurology, Department of NeurologyMayo ClinicRochesterUSA

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