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The direct counter-example to the belief that apnoea testing is dangerous on a circuit. Against a pooled non-confirmatory rate of 22%, a unit with a written technique that keeps the lungs open completed every test. The difference is the protocol, not the patient - and keeping positive end-expiratory pressure applied is where the oxygenation safety comes from.
Non-ECMO patients, and patients hypoxic against non-hypoxic at baseline
DOI 10.1007/s00134-015-4105-6
Apnoea test technique combining applied positive end-expiratory pressure with subsequent pulmonary recruitment
Single centre, retrospective, 25 ECMO patients; the comparison with pooled practice is indirect. Structured abstract only. [VERIFICATION REQUIRED]
No apnoea test was aborted and no severe complication occurred; the test was completed in every patient. Fluid boluses were required in under 10% and initiation or escalation of vasoactive drugs in under 3%, with no clinically meaningful haemodynamic change. Severe hypoxia (arterial oxygen tension under 40 mmHg) occurred in 7 (2.4%) non-ECMO and 4 (8%) ECMO tests (P = 0.063), and more often in patients hypoxic at baseline (11.1% against 4.8%, P = 0.002).
169 consecutive brain-dead patients at one centre, 2010-2014, including 25 on venoarterial ECMO - the largest ECMO cohort reported