Emergency ECMO Deployment During Liver Transplantation in Portopulmonary Hypertension Patients.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Joao Da Costa Rodrigues, Corinne Gazarian, Julien Maillard, Gergely Albu, Benjamin Assouline, Frédéric Lador, Eduardo Schiffer
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Abstract

BACKGROUND Portopulmonary hypertension (POPH) is part of Group 1 of the clinical classification of pulmonary hypertension and represents 5-15% of patients with pulmonary hypertension, with a 5-year mortality rate of 40%. The implementation of preoperative pulmonary antihypertensive treatment allows liver transplantation depending on clinical response, which constitutes potential curative treatment. Uncontrolled pulmonary hypertension is a major risk factor of perioperative morbimortality in the context of liver transplantation. In case of major hemodynamic instability, extracorporeal membrane oxygenation (ECMO) can be placed to manage circulatory failure. We describe a case of a patient with POPH in whom an emergency ECMO was implanted during liver transplantation complicated by an intraoperative worsening of pulmonary vascular resistances leading to cardiac arrest. CASE REPORT A 16-year-old patient with POPH had an orthotopic liver transplantation (OLT) after management of pulmonary hypertension with a triple antihypertensive therapy, which was complicated by hemorrhagic shock. Management of hemorrhagic shock led to greatly increased pulmonary vascular resistances, which led to a perioperative cardiac arrest, necessitating the implantation of a veno-arterial ECMO, allowing the completion of critical surgical steps before admission to the intensive care unit. CONCLUSIONS POPH is a challenge in the perioperative setting. OLT is a therapeutic option in that setting. ECMO may be necessary for patients with POPH in the perioperative hemodynamic management during OLT. In highly selected cases, VA-ECMO implantation and timing should be discussed by a multidisciplinary team before induction. The emergency perioperative implantation of ECMO is a realistic alternative.

门脉肺动脉高压患者肝移植过程中的紧急ECMO部署。
门脉性肺动脉高压(POPH)是肺高压临床分类第1组的一部分,占肺高压患者的5-15%,5年死亡率为40%。术前肺降压治疗的实施,根据临床反应,允许肝移植,这是潜在的治愈性治疗。未控制的肺动脉高压是肝移植围手术期病死率的主要危险因素。在主要的血流动力学不稳定的情况下,体外膜氧合(ECMO)可以放置来管理循环衰竭。我们描述了一例POPH患者,在肝移植期间植入了紧急ECMO,术中肺血管阻力恶化导致心脏骤停。病例报告:一名16岁的POPH患者在三重降压治疗肺动脉高压后,并发失血性休克,行原位肝移植(OLT)。失血性休克的处理导致肺血管阻力大大增加,导致围手术期心脏骤停,需要植入静脉-动脉ECMO,以便在进入重症监护病房之前完成关键的手术步骤。结论:POPH在围手术期是一个挑战。在这种情况下,OLT是一种治疗选择。在OLT的围术期血流动力学管理中,ECMO对POPH患者可能是必要的。在高度选定的病例中,VA-ECMO植入和时机应在诱导前由多学科团队讨论。围手术期紧急植入术是一种现实的选择。
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来源期刊
American Journal of Case Reports
American Journal of Case Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
599
期刊介绍: American Journal of Case Reports is an international, peer-reviewed scientific journal that publishes single and series case reports in all medical fields. American Journal of Case Reports is issued on a continuous basis as a primary electronic journal. Print copies of a single article or a set of articles can be ordered on demand.
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