The challenges with XXXX determination in adult @entity1 on extracorporeal membrane oxygenation.

@entity1 @entity515 @entity177 @entity1620 @entity386
BACKGROUND: To identify a reliable method of performing @entity386 testing as part of @entity1620 determination in adult @entity1 who develop loss of brainstem reflexes while receiving extracorporeal membrane oxygenation (ECMO). ECMO provides extracirculatory support to @entity1 in @entity177 who would otherwise be expected to die. Many studies have reported @entity1620 as a potential complication of adult ECMO, but none have cited how @entity386 testing was performed in these @entity1 . METHODS: This retrospective review identified adults 15 years or older treated with ECMO at our institution (2002-2010) and the method of determination of @entity1620 when complete loss of brainstem reflexes occurred. RESULTS: Loss of all brainstem reflexes was identified in three cases (3/87, 3.4%). The @entity386 test was not performed since it was deemed "difficult," leading to withdrawal of ECMO and intensive care. Ancillary tests such as cerebral flow studies were not used because they may not document absent cerebral arterial flow due to the ischemic nature of the injury. We propose the use of an oxygenated @entity386 test on ECMO using continuous positive airway pressure (CPAP) through the ventilator or anesthesia bag, with an inline manometer and an end tidal @entity515 device. CONCLUSION: @entity386 testing is essential in the determination of @entity1620 , but may not be employed in ECMO-treated adult @entity1 . @entity386 testing using the above protocol may assist in better decision making for adult ECMO @entity1 at risk of @entity1620 .
