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Radosevich M, Anderson A, Teixeira M, Diwan T, Heimbach J, Taner T, Spencer P, Diaz Soto J, Reynolds A, Neff A, Krowka M, Bohman J. Practical Considerations for Extracorporeal Membrane Oxygenation Use During Orthotopic Liver Transplantation. J Cardiothorac Vasc Anesth 2025; 39:803-812. [PMID: 39668049 DOI: 10.1053/j.jvca.2024.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/28/2024] [Accepted: 11/20/2024] [Indexed: 12/14/2024]
Abstract
Patients undergoing liver transplantation infrequently require extracorporeal membrane oxygenation (ECMO) support. However, when ECMO is required in the peritransplant period, several key considerations are required to maximize the efficacy of its support and minimize the risks of complications. This review seeks to briefly summarize the existing data supporting the use of ECMO in liver transplant patients and offers expert technical and practical advice from the authors' high-volume liver transplant center and ECMO program.
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Affiliation(s)
- Misty Radosevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Alexandra Anderson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Miguel Teixeira
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Ty Diwan
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Julie Heimbach
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Timucin Taner
- Department of Transplant Surgery, Mayo Clinic, Rochester, MN
| | - Philip Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Juan Diaz Soto
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Alex Reynolds
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Alexis Neff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Michael Krowka
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - John Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Laporte CCM, Brown B, Wilke TJ, Kassel CA. 2023 Clinical Update in Liver Transplantation. J Cardiothorac Vasc Anesth 2024; 38:1390-1396. [PMID: 38490899 DOI: 10.1053/j.jvca.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024]
Abstract
Liver transplantation continues to provide life-saving treatment for patients with end-stage liver disease. Advances in the field of transplant anesthesia continue to support the care of more complex patients. The use of extracorporeal membrane oxygenation has been described in critical care settings and cardiac surgery but may be a valuable option for specific conditions for patients undergoing liver transplantation. Changes to the allocation process for liver grafts now focus on acuity circles to reduce regional disparities. As the number of life-saving transplant surgeries increases, so does the need for specialty knowledge in the anesthetic considerations of these procedures. The specialty of transplant anesthesia continues to grow and develop to meet the demands of complex patients and the increased number of transplants performed. Liver transplantation can be a resource-demanding procedure, and predicting the need for massive transfusion can aid in planning and preparing for significant blood loss.
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Affiliation(s)
| | - Brittany Brown
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Trevor J Wilke
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Cale A Kassel
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
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