Brain death determination during ECMO

Abstract

Extracorporeal membrane oxygenation (ECMO) is widely used in the intensive care unit to treat severe respiratory and/or circulatory failure. Outside Japan, determination of Brain death/Death by neurologic criteria (BD/DNC) and subsequent organ donation under ECMO have been reported. However, as of September 2021, BD/DNC has not yet been formally confirmed for any patient under ECMO in our country. A project to harmonize practice and improve the rigor of BD/DNC criteria has been started and published (Greer DM, et al. JAMA. 2020). Based on this recommendation, we raise the difficulties for determining BD/DNC in patients under ECMO in Japan. Several issues must be addressed before making a first determination of BD/DNC under ECMO in our country. The Japanese protocol for BD/DNC determination should be modified. Performing an apnea test for a patient receiving ECMO requires standardization. Patients whose BD/DNC needs to be confirmed under ECMO will arise in our nation in the near future. It is important to accumulate knowledge on BD/DNC determination under ECMO.