24, 28, 68
National directives differ and are changing faster than international guidance. One 2026 national update now forbids cerebral blood flow-based ancillary tests in potential donors on venoarterial ECMO as insufficiently validated, and requires that apnoea testing be accompanied by physicians familiar with the circuit. Local criteria, not this guideline, govern practice.
Obtain and read the ECMO-specific recommendations before writing a local protocol. Published practice on which Chapter 24 is based converges on: pre-oxygenate through both lungs and circuit; reduce the sweep gas to 0.5 to 1 L/min and hold the blood flow constant; keep the lungs open with applied positive end-expiratory pressure; sample simultaneously from right and left radial arteries on venoarterial support; add exogenous carbon dioxide or carbogen if the tension will not rise; treat an aborted test as uninterpretable rather than negative; and have the ECMO team present.
[VERIFICATION REQUIRED - the guideline document was NOT retrieved and no recommendation is quoted here or anywhere in Chapter 24.] The 2023 consensus guideline of the American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society and Society of Critical Care Medicine unifies adult and paediatric determination of death by neurologic criteria into a single document of 85 recommendations, developed by an evidence-informed formal consensus process because of the lack of high-quality evidence. It is the first major guideline to include explicit guidance for conducting the evaluation in the context of extracorporeal membrane oxygenation, alongside targeted temperature management and primary infratentorial injury. Its ECMO-specific recommendations are identified as a standing retrieval target and have not been obtained.
Brain death determination on a circuit