LAUSR

www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Neurological determination of death (NDD) is predominantly a clinical diagnosis. After confirmation of the absence of any cranial nerve responses, an apnea test is conducted to confirm the absence of spontaneous breathing movements. When clinical diagnosis is impossible, an additional ancillary test is required. We aimed to describe NDD practices and associated complications in the context of 8 of the first centres participating in the CanadaDONATE National Cohort Study. Methods: This 12 month observational study in 8 centres and 2 provinces included consecutive consented NDD donors who had underwent apnea testing. We recorded donor age, sex, and comorbidities that could affect the conduct of apnea test. We also recorded, primarily retrospectively, vital signs at the start of apnea testing, apnea test methods (connected or not to ventilator, use of PEEP, oxygen flow, duration), the use of ancillary testing and any complications that occurred. We provide descriptive statistics for current practices regarding NDD practices. Results: 101 consecutive NDD donors are included in this analysis. Median age was 55 years (IQR 39–67), of which 37% were female. Sixteen percent had chronic obstructive lung disease, 26% were smokers and 6% had coronary disease. Complete data regarding the apnea test was available for 95 patients. The patients had stable vital signs prior to apnea test with a median arterial saturation of 99% (IQR 98–100) and mean arterial pressure of 82 mmHg (IQR 74–93), although 79% were receiving vasopressor support. The apnea test was performed with a connection to the ventilator for 20% of patients. For the remaining patients, the median oxygen flow was 10L/min (IQR 6–10) and 83% used a PEEP valve. The median apnea test duration was 12 minutes (IQR 10–15) and 91% confirmed neurological death. Ancillary testing for NDD was undertaken in 19% of patients. Complications during apnea test were rare with 1 patient developing a new episode of arrhythmia and 1 patient presenting a new episode of hypotension. Conclusions: These preliminary data from the Canada-DONATE study reveal varied NDD practices. Despite practice variations, NDD methods in use appear safe. The ongoing observational study will provide further information regarding NDD practices nationally and may help to define optimal practices.