儿童体外膜肺支持下脑死亡判定

Determination of brain death in child patients on extracorporeal membrane oxygenation

目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下重症儿童脑死亡判定方法。方法通过报告两个中心3例ECMO支持下重症患儿脑死亡判定实施过程,总结目前国内外文献报告的案例经验。结果3例患儿在临床判断为脑死亡和完成确认试验后,通过撤离呼吸机和逐步下调气流量方法进行自主呼吸激发试验的判定,患儿均确认脑死亡。结论通过逐渐下调气流量方法在ECMO下进行儿童脑死亡的自主呼吸激发试验安全可行,为我国儿童脑死亡判定的安全实施做出探索。

Objective Apnea tests in the determination of brain death in child patients on extracorporeal membrane oxygenation(ECMO)remain challenges.The study aimed at exploring an implementation method of apnea test in those patients.Methods A total of 3 pediatric cases supported by venous-arterial ECMO in two tertiary care PICUs underwent evaluation of brain death.After neurologic examinations demonstrated cessation of brain function in accordance with brain death guidelines,apnea testing was performed on each child on ECMO.Meanwhile,literature reviews were conducted to summarize relevant experience on apnea test.Results The three children suffered with drowning,gas poisoning or congenital heart disease respectively.After clinically judged as brain death,they were assessed by four qualified doctors two times.The apnea test was conducted by withdrawing the ventilator and gradually reducing sweep gas flow rate.The process was safe,and those children were finally confirmed to be brain-dead.Conclusion Determination of brain death under ECMO remains challenging in children.Apnea test is the key part in the determination of brain death.It is safe and feasible to conduct apnea test for children on ECMO by gradually reducing sweep gas flow rate.