Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome

Kumar, Lakshmi; Balakrishnan, Dinesh; Varghese, Rekha; Sudhindran, S.

doi:10.1136/bcr-2017-221381

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…There are only five prior reports of ECMO use in patients with HPS refractory to LT, of which the longest period was 28 days. 1–5 Since ECMO was employed for a total of 67 days in the present case, it is the longest period reported in the literature to date.…”

Section: Discussionmentioning

confidence: 90%

“…In such cases, additional measures may be taken to manage hypoxemia, including the use of inhaled vasodilators and systemic vasoconstrictors. There have been very few successful reports on the use of extracorporeal membrane oxygenation (ECMO), 1–5 lasting up to 4 weeks, since time to recover varies among these patients Herein, we report the case of an HPS patient with refractory hypoxemia who underwent LT and had a satisfactory response after 9 weeks on ECMO.…”

Section: Introductionmentioning

confidence: 99%

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Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support

et al. 2021

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Hepatopulmonary syndrome (HPS) is a complication of end stage liver disease (ESLD) and is manifested by severe hypoxemia, which usually responds to liver transplantation (LT). As compared to patients undergoing LT for other etiologies, patients with HPS present an increased risk of postoperative morbidity and mortality. There is no effective treatment for patients whose hypoxemia does not respond to LT. This subset of patients is at a highly increased risk of death. There are very few reports on the use of extracorporeal membrane oxygenation (ECMO) in this setting with rapid response. However, there is no prior report of ECMO utilization for longer than 4 weeks. We present the case of a 17 year-old male patient who underwent LT for ESLD secondary to chronic portal vein thrombosis and HPS. He received a liver from a deceased donor and presented with severe HPS after LT, requiring ECMO support for 67 days. The patient was discharged home and is breathing in ambient air. He is currently asymptomatic and has a normal liver function.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support

et al. 2021

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“…Although the syndrome was first described in 1884, besides LT, there is still not an effective treatment [ 106 ]. Intraoperative strategies to improve oxygenation include the use of methylene blue and extracorporeal membrane oxygenation (ECMO) [ 107 , 108 ].…”

Section: Hepatopulmonary Syndromementioning

confidence: 99%

The Edge of Unknown: Postoperative Critical Care in Liver Transplantation

Saner

Hoyer

Hartmann

et al. 2022

JCM

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Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present the most up-to-date information regarding predicting and treating hemodynamic instability, coagulation monitoring and management, postoperative ventilation strategies and early extubation, management of infections, and ESLD-related pulmonary complications. In addition, early post-transplant allograft dysfunction will be discussed.

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“…9. [35][36][37][38][39][40][41][42] Cost is the main hurdle in many of the indicated patients who are deprived of the benefit of ECMO support in India. Limited centers/ hospitals have the facility of ECMO.…”

Section: Indian Overview With Ecmomentioning

confidence: 99%

Extracorporeal membrane oxygenation: Perioperative clinical practices and the Indian overview

Das¹,

Uma²,

Kumar³

et al. 2020

IJCA

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Extracorporeal membrane oxygenation (ECMO) has emerged as a mechanical circulatory support system with rapid advancements in its technology. It has become an essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional therapy. The ease of implementation and cost effectiveness makes it highly desirable alternative for bridge to recovery or decision especially in developing countries like India. However complications and challenges related to ECMO, require more rigorously designed studies towards redefining management of patients. Anaesthesiologist being the perioperative physician has an impotant role in managing patients with ECMO. This review focuses on fundamental principles, technology, indications, management, weaning, transport protocols, complications, future directions as well as Indian scenario with ECMO utilization.

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Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome

Cited by 11 publications

References 14 publications

Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support

Severe hepatopulmonary syndrome with hypoxemia refractory to liver transplant: Recovery after 67 days of ECMO support

The Edge of Unknown: Postoperative Critical Care in Liver Transplantation

Extracorporeal membrane oxygenation: Perioperative clinical practices and the Indian overview

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