Apnea test induced barotrauma in an obese subject with a short neck - A case report

Death is an assured inevitability event for all living beings of this cosmos. Based on the American Academy of Neurology (AAN) recommendations, clinical diagnosis of Brain Death (BD) includes multiple sequences of tests. The Apnea Test (AT) is a more significant procedure in diagnosing BD. Unfortunately, complications during this procedure can occur more frequently than documented, and its incidence is limited to case reports. However, most critical care physicians and Cardio-respiratory therapists consider an AT a principal method to confirm BD as it provides decisive information about the definitive loss of brainstem function. Here, we describe the execution of the AT procedure that transpired into extensive subcutaneous emphysema, tension pneumothorax, and pneumoperitoneum followed by pulseless electrical activity due to direct airway perforation by the supplemental oxygen catheter. In addition, we do a literature review on airway complications incidence and suggest methods to avoid such fatal complications. Finally, further prospective studies are recommended to evaluate the barotrauma incidence and complication nature during AT.