Hemodynamic Monitoring During Liver Transplantation for Patients on Perioperative Extracorporeal Membrane Oxygenation (ECMO) Support: A Narrative Review.

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Stefano Tigano, Giulio Casolaro, Amedeo Bianchini, Enrico Bernardi, Cristiana Laici, Linda Ramahi, Giovanni Vitale, Antonio Siniscalchi
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Abstract

Background and Objectives: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is made possible by donations made after circulatory death (DCD). Liver transplantation (LT) in such high-risk patients may be challenging and may require perioperative Extracorporeal Membrane Oxygenation (ECMO). There is a lack of evidence on the best hemodynamic monitoring techniques for patients undergoing ECMO support during the perioperative period of LT. This review aims to provide a comprehensive overview of the hemodynamic monitoring standards of patients supported by ECMO before, during, and after LT. Materials and Methods: Comprehensive research was conducted through the PubMed database, and 153 articles regarding patients who needed perioperative ECMO support were found. Among these, 18 articles were finally included in our analysis as the authors specified hemodynamic monitoring techniques and data. The articles included case reports, letters to the editor, and correspondence. Results: We identified 20 cases of patients supported by ECMO as a planned preoperative strategy (9 patients), as a rescue therapy during surgery (7 patients), and as a postoperative support (4 patients). Cardiac catheterism and echocardiography (transthoracic and transesophageal) were the authors' most cited hemodynamic monitoring techniques. Conclusions: Data on hemodynamic monitoring methods used to manage patients supported by ECMO during the whole perioperative period of LT are poor and derived from descriptive low-quality studies. However, a multimodal approach that includes continuous monitoring of pulmonary pressures and echocardiography can increase diagnostic accuracy and improve the decision-making process to manage this complex patient population.

肝移植患者围手术期体外膜氧合(ECMO)支持的血流动力学监测:述评。
背景和目的:由于越来越多的有心血管和呼吸危险因素的患者接受肝移植手术,肝移植的适应症在世界范围内不断增加。对这一趋势的进一步支持来自越来越多地使用边缘器官,这是通过在循环性死亡(DCD)后捐赠来实现的。肝移植(LT)在这样的高危患者可能是具有挑战性的,可能需要围手术期体外膜氧合(ECMO)。关于lt围手术期ECMO支持患者的最佳血流动力学监测技术缺乏证据。本综述旨在全面概述lt前、lt中、lt后ECMO支持患者的血流动力学监测标准。材料与方法:通过PubMed数据库进行综合研究,找到153篇关于围手术期ECMO支持患者的文章。其中,18篇文章作为作者指定的血流动力学监测技术和数据最终纳入我们的分析。这些文章包括病例报告、给编辑的信件和通信。结果:我们确定了20例患者采用ECMO作为术前计划策略(9例)、术中抢救治疗(7例)和术后支持(4例)。心导管和超声心动图(经胸和经食管)是作者引用最多的血流动力学监测技术。结论:用于管理全LT围手术期ECMO支持患者的血流动力学监测方法的数据较差,并且来自描述性低质量研究。然而,包括连续监测肺动脉压和超声心动图在内的多模式方法可以提高诊断准确性,改善决策过程,以管理这一复杂的患者群体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medicina-Lithuania
Medicina-Lithuania 医学-医学:内科
CiteScore
3.30
自引率
3.80%
发文量
1578
审稿时长
25.04 days
期刊介绍: The journal’s main focus is on reviews as well as clinical and experimental investigations. The journal aims to advance knowledge related to problems in medicine in developing countries as well as developed economies, to disseminate research on global health, and to promote and foster prevention and treatment of diseases worldwide. MEDICINA publications cater to clinicians, diagnosticians and researchers, and serve as a forum to discuss the current status of health-related matters and their impact on a global and local scale.
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