Extracorporeal Membrane Oxygenation Can Save Lives in Children With Heart or Lung Failure After Liver Transplantation

Abstract

The risk of cardiac or lung failure after liver transplantation (LT) is significant. In rare cases, the usual intensive care techniques fail to maintain organ oxygenation with a risk of multiorgan dysfunction. Although extracorporeal membrane oxygenation (ECMO) is a difficult and risky procedure, it can be proposed as life-saving. Four children with either acute pulmonary (three) or cardiac (one) failure after LT, and the criteria that decided the use of ECMO (level of ventilation and results, dosage of inotropic drugs, cardiac ultrasound, blood lactate) were retrospectively reported. These patients, 1-11 years old, were treated with either veno-arterial (three) or veno-venous (one) ECMO. Two experienced a full recovery, with 3 and 6 years of follow-up. Two died of systemic inflammatory response syndrome (SIRS) due to ECMO, and relapse of heart failure due to the underlying disease. Although our patients' survival was only 50%, we showed that ECMO can be useful in children after LT. It should be considered before the development of irreversible multiorgan failure.

Extracorporeal Membrane Oxygenation in Pediatric Liver Transplantation: A Multicenter Linked Database Analysis and Systematic Review of the Literature

“…7,35 Additionally, many patients have an indication for LT associated with a condition predisposing them to either respiratory or cardiovascular failure as is seen with HPS, portopulmonary hypertension, pulmonary artery stenosis in Alagille syndrome, or cardiomyopathy of metabolic disease. 4,5,21,35,36 Many of these conditions can be acutely exacerbated by the hemodynamic changes associated with LT and result in mortality without the temporary respiratory and cardiovascular support provided by ECMO. Institution of ECMO after failure of traditional resuscitation measures has a survival of 28.6%-44.4% in adult LT patients.…”

“…From 24 articles initially identified as potentially eligible, 16 studies were retrieved for data extraction after fulltext review (Figure 2). The studies included in the present systematic review were published between 2000 and 2020 and were conducted in the United States (n = 7), 8,9,[18][19][20][21][22] Asia (n = 5), 7,12,[23][24][25] Europe (n = 3), [4][5][6] and Canada (n = 1). 26 A total of 22 children that received ECMO on the day of transplant or later were included in the systematic review (Table 4).…”

“…[4][5][6][7] Extracorporeal membrane oxygenation (ECMO) is a life-supporting intervention that can provide either isolated gas exchange for support of acute respiratory failure (venovenous [VV]) or combined gas exchange and hemodynamic support for the treatment of combined cardiorespiratory failure (venoarterial [VA] or venoarterial-venous) refractory to conventional treatment. 5 Early implementation of life-supporting interventions, such as ECMO, have been utilized to bridge critically ill pediatric LT recipients with recoverable respiratory and cardiovascular failure. 4,[7][8][9] Although the outcomes of adult LT patients requiring ECMO have been described, [10][11][12] data in children are limited to case reports and small case series.…”

Central ECMO for circulatory failure following pediatric liver transplantation

“…Indications for ECMO include reversible circulatory and/or respiratory failure with inadequate oxygen delivery. There remains limited data on ECMO therapy for sepsis following LT. 1,2 Lee et al reported on ECMO rescue for refractory sepsis post-LT in a series of 8 adults and found 25% survival. 1 Of note, survivors exhibited prompt reduction in lactic acidosis after initiation of ECMO, similar to our patient.…”

Artificial Organs 2017: A Year in Review

“…Jean et al of the Hôpital Armand‐Trousseau, Paris, France investigated the use of ECMO in four children with either pulmonary of cardiac failure after liver transplantation. Two achieved a full recovery with 3‐ and 6‐years follow up while two died of systemic inflammatory response syndrome due to ECMO.…”