Veno-arterial extracorporeal membrane oxygenation as an intraoperative rescue option in case of portopulmonary hypertension recognized during liver transplantation

Burgio, Gaetano; Lullo, Fabio; Panarello, Giovanna

doi:10.23736/s0375-9393.17.12224-8

Cited by 24 publications

(15 citation statements)

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“…Reduce the RV afterload with inhaled nitric oxide or intravenous prostacyclins (20-40 ng/kg/min) [11,64]. In unresponsive patients ECMO may be necessary as a life-saving measure [65].…”

Section: Management Of Decompensated Pah and Acute Rvfmentioning

confidence: 99%

“…The application of ECMO to patients during the liver transplantation perioperative period may help recipients with severe cardiac disease to maintain the heart function and alleviate the reperfusion syndrome; however, its use is limited out of concern of the need for anticoagulation [66]. ECMO has been mainly used as an intraoperative rescue option during liver transplantation [65]. Prophylactic ECMO use as a measure to prevent cardiocirculatory failure has been successfully used in liver transplantation [66].…”

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

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Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Kandil

2019

Current Opinion in Organ Transplantation

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Purpose of reviewLiver transplantation in patients with portopulmonary hypertension (POPH) is associated with increased perioperative risk. Important recent advances in the management of liver transplantation recipients with POPH are discussed. Recent findingsThe presence of POPH at the time of liver transplantation should not be a contraindication for liver transplantation, as POPH is common and may be related to volume overload and/or high cardiac output (CO). Available data suggest that patients with mild POPH (25-35 mmHg) can safely undergo liver transplantation surgery. In more severe cases, treatment of POPH with a combination of vasoactive drugs may lead to successful liver transplantation with normalization of POPH. The key to successful intraoperative anesthetic management is maintaining the right ventricular preload and avoiding right ventricular dysfunction. Techniques include diuresis, intraoperative hemodialysis, venovenous bypass, or extracorporeal membrane oxygenation. Apart from the surgical and anesthetic techniques used, factors that contribute to increased pulmonary vascular resistance have to be avoided and the continuation of the vasodilators into the intraoperative and postoperative periods is crucial.

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“…Reduce the RV afterload with inhaled nitric oxide or intravenous prostacyclins (20-40 ng/kg/min) [11,64]. In unresponsive patients ECMO may be necessary as a life-saving measure [65].…”

Section: Management Of Decompensated Pah and Acute Rvfmentioning

confidence: 99%

Section: Extracorporeal Membrane Oxygenationmentioning

confidence: 99%

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Kandil

2019

Current Opinion in Organ Transplantation

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“…While complications were high (84%), with bleeding being the most common cause (44%), overall mortality was relatively low (26%), given the severity of patients' illnesses 21 . Although there is a limited report of intraoperative VA‐ECMO in adult, 22 to the best of our knowledge, no reports have been retrieved on pediatric cases rescued intraoperatively by VV‐ECMO during LT.…”

Section: Discussionmentioning

confidence: 99%

Rescue venovenous extracorporeal membrane oxygenation for the deterioration of acute respiratory distress syndrome in pediatric liver transplantation

Shimura

Matsumoto

Ide

et al. 2022

Pediatric Transplantation

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Background Twenty percent of pediatric patients with BA develop ACLF with increased mortality while awaiting LT. Respiratory complications are common in pediatric ACLF and are associated with increased morbidity and mortality. ARDS is the most severe manifestation of acute respiratory failure with considerable risk of mortality. Methods A 5‐month‐old girl with post‐Kasai BA preoperatively experienced ARDS from RSV infection while awaiting LT. She developed decompensated liver failure with shock, acute kidney injury, coagulopathy, and pulmonary hemorrhage after several episodes of sepsis over the course of 1 month in the PICU. At this stage, RSV was not detected in the patient's tracheal aspirate by real‐time polymerase chain reaction. She underwent living donor LT to manage her pre‐existing critical state. Following reperfusion during LT, her pre‐existing ARDS rapidly deteriorated, which was alleviated by intraoperative VV ECMO. Results Severe respiratory acidosis improved rapidly following ECMO, and LT was completed uneventfully. The patient was successfully weaned off ECMO on POD 3. Conclusions This is the first pediatric case rescued by the intraoperative application of ECMO during LT. Our case and cumulative evidence suggest that VV ECMO can serve as rescue therapy for perioperative refractory respiratory failure in pediatric LT.

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“…Thirteen case studies and series were identified comprising 31 individual cases of VA-ECMO (n = 23) or CPB use (n = 8) in adult LT patients (Table 3). 4,5,8,12,13,17,18,22,23,[26][27][28][29] In total, 17 of 31 patients survived to discharge (55%). Survival among patients requiring ECPR was 56% (10/18).…”

Section: Ecls For Cardiac Failurementioning

confidence: 99%

Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

et al. 2021

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The use of extracorporeal life support (ECLS) is increasingly reported in adult liver transplantation (LT). However, neither the role of ECLS in the perioperative setting for LT nor its outcomes has been well defined. We performed a retrospective chart review of all adult LT patients at our institution who received ECLS from 2004 to 2021. We also conducted a comprehensive literature search for adult LT cases that involved perioperative ECLS for respiratory or cardiac failure. Over the study period, 11 LT patients required ECLS at our institution, two for respiratory and nine for cardiac failure. Both patients with respiratory failure received ECLS as a bridge to LT and survived to discharge. Nine patients required ECLS for acute cardiac failure either intraoperatively or postoperatively, and two survived to discharge. In the literature, we identified 35 cases of respiratory failure in LT patients requiring perioperative ECLS. Applications included preoperative bridge to LT (n = 6) and postoperative rescue (n = 29), for which overall survival was 44%. We identified 31 cases of cardiac failure in LT patients requiring either ECLS or cardiopulmonary bypass for cardiac support or rescue for intraoperative or postoperative cardiac failure (n = 30). There is evidence for consideration of ECLS as a bridge to LT in patients with potentially reversible respiratory failure or as rescue therapy for respiratory failure in posttransplant patients. ECLS has a prohibitively high risk of futility in pretransplant patients with cardiac failure but may have a role in LT patients with a functioning graft and potentially reversible cardiac failure.

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Veno-arterial extracorporeal membrane oxygenation as an intraoperative rescue option in case of portopulmonary hypertension recognized during liver transplantation

Cited by 24 publications

References 0 publications

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension

Rescue venovenous extracorporeal membrane oxygenation for the deterioration of acute respiratory distress syndrome in pediatric liver transplantation

Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

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