ID:152 FC-PC2-3 The Role of Clinical Engineer in Organ Transplantation After Legal Brain Death Determination Under V-A ECMO

Background: This is the first case in Japan where legal brain death determination and organ removal under V-A ECMO were performed at our hospital. I report my experience as a clinical engineer. Method: Legal brain death determination under V-A ECMO differs from normal brain death determination in the methods of 1) confirming the absence of spontaneous breathing and 2) confirming flat EEG. Because post-oxygenation blood sampling is required to confirm the loss of spontaneous breathing, we discussed with the emergency physician and adjusted the ECMO oxygen concentration/oxygen flow rate settings. To confirm flat EEG, we adjusted the medical equipment to prevent noise from entering the EEG. Furthermore, prior to organ removal, we met with the transplant team and relevant staff to confirm the surgical procedure and ECMO operation. Results: During legal brain death determination, ECMO settings and post-oxygenation blood sampling were performed without any problems, and the loss of spontaneous breathing was confirmed. By implementing measures to prevent EEG noise, we were able to obtain flat EEG. After the organ removal surgery began, the ECMO operation was smoothly completed, and the organ was successfully removed and transplanted at another hospital. Conclusion: The clinical engineer played an important role in determining legal brain death under V-A ECMO.