Determination of brain death under extracorporeal life support

Excerpt

The worldwide use of extracorporeal lung/life support is increasing in severe lung failure (veno-venous extracorporeal membrane oxygenation, vvECMO) or in cardiac arrest/severe circulatory failure (veno-arterial ECMO, vaECMO). ECMO presents a new level of technology; but at the same time, ECMO has created a new field in medical ethics [1]. In recent years, the in-hospital mortality of patients treated with ECMO has remained high [2], and in specific indications for ECMO, such as vaECMO for cardiopulmonary resuscitation, the prognosis of (good) neurologic recovery is often unclear or poor. Consequently, the number of patients diagnosed with brain death under ECMO treatment will rise. Two retrospective analyses reported 161 brain-dead ECMO-supported patients (National French Registry of 22,270 donors after brain death between 2007 and 2013 [3]), and 100 brain deaths out of 356 ECMO patients with neurologic complications (Extracorporeal Life Support Organization data bank from 350 ECMO centers during 1992–2015: 4988 adults [4]), respectively. Since further increase of ECMO use is expected, and the estimation of brain death sometimes marks the end of strenuous therapeutic efforts, accurate knowledge about the specific challenges of brain death diagnosis under the circumstances of ECMO treatment is indispensable. …