A novel escalation from veno-venous bypass to veno-venous ECMO during orthotopic liver transplantation. A case report

We describe the challenging perioperative course of a 55-year-old patient with hepatic failure requiring liver transplantation (LT). Different modalities of the extracorporeal device were successfully used, ranging from veno-veno bypass to partial and full veno-veno extracorporeal membrane oxygenation (ECMO) in order to optimize preload, reduce bleeding from the collateral circulation, optimize acid base balance and/or improve oxygenation. The case highlights the potential use of the device as a rescue method in challenging cases. Furthermore this is the first documented case that extracorporeal CO2 removal (ECCO2R) is used to optimize the biochemistry profile intraoperatively during a LT. The patient was weaned off the device at the end of the case and has been discharged home.

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Effects of a passive venous bypass on cardiovascular and acid-base balance variables during liver transplantations in pigs

Journal of Cardiothoracic Anesthesia ◽

10.1016/0888-6296(87)90040-8 ◽

1987 ◽

Vol 1 (6) ◽

pp. 535-542 ◽

Cited By ~ 2

Author(s):

Johann Motsch ◽

Franz Alto Zimmermann

Keyword(s):

Acid Base Balance ◽

Acid Base ◽

Venous Bypass ◽

Liver Transplantations ◽

Base Balance

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Successful resuscitation after hyperkalemic cardiac arrest during liver transplantation by converting veno-venous bypass to veno-arterial ECMO

Perfusion ◽

10.1177/0267659120963898 ◽

2020 ◽

pp. 026765912096389

Author(s):

Lucas Van Hoof ◽

Filip Rega ◽

Sarah Devroe ◽

Karlien Degezelle ◽

Jacques Pirenne ◽

...

Keyword(s):

Liver Transplantation ◽

Cardiac Arrest ◽

Case Report ◽

Cardiopulmonary Resuscitation ◽

Extracorporeal Membrane Oxygenation ◽

Neurological Outcome ◽

Successful Resuscitation ◽

Venous Bypass ◽

Anhepatic Phase ◽

Va Ecmo

Introduction: Intraoperative cardiac arrest (ICA) is a feared complication during liver transplantation (LTx), typically occurring during reperfusion. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used for post-reperfusion cardiac arrest. Case report: We present a case of successful resuscitation after hyperkalemic ICA during the pre-anhepatic phase of a second liver transplantation by converting veno-venous bypass (VVB) to VA-ECMO. Discussion: While this technique has been recommended for ICA during reperfusion, it has never been reported during the pre-anhepatic phase. VA-ECMO can be a lifesaving extension to cardiopulmonary resuscitation for ICA during LTx with beneficial neurological outcome by providing perfusion while the cause of ICA is reversed. Conclusion: Conversion of VVB to VA-ECMO should be considered in all patients who suffer from ICA during LTx with use of VVB. With VVB installed, conversion to VA-ECMO is fast and effective. If VVB is not used, early VA-ECMO should be considered for ICA.

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Dichloroacetate stabilizes the intraoperative acid-base balance during liver transplantation

Liver Transplantation ◽

10.1002/lt.21485 ◽

2008 ◽

Vol 14 (7) ◽

pp. 989-998 ◽

Cited By ~ 4

Author(s):

Robert E. Shangraw ◽

Deirdre Lohan-Mannion ◽

Agnes Hayes ◽

Rose M. Moriarty ◽

Rongwei Fu ◽

...

Keyword(s):

Liver Transplantation ◽

Acid Base Balance ◽

Acid Base ◽

Base Balance

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Higher Dietary Acidity is Associated with Lower Bone Mineral Density in Postmenopausal Iranian Women, Independent of Dietary Calcium Intake

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000207 ◽

2014 ◽

Vol 84 (3-4) ◽

pp. 0206-0217 ◽

Cited By ~ 8

Author(s):

Seyedeh-Elaheh Shariati-Bafghi ◽

Elaheh Nosrat-Mirshekarlou ◽

Mohsen Karamati ◽

Bahram Rashidkhani

Keyword(s):

Calcium Intake ◽

Dietary Calcium ◽

Dietary Calcium Intake ◽

Dietary Intakes ◽

Iranian Women ◽

Acid Base Balance ◽

Mineral Density ◽

Acid Base ◽

Base Balance ◽

Dietary Acid

Findings of studies on the link between dietary acid-base balance and bone mass are relatively mixed. We examined the association between dietary acid-base balance and bone mineral density (BMD) in a sample of Iranian women, hypothesizing that a higher dietary acidity would be inversely associated with BMD, even when dietary calcium intake is adequate. In this cross-sectional study, lumbar spine and femoral neck BMDs of 151 postmenopausal women aged 50 - 85 years were measured using dual-energy x-ray absorptiometry. Dietary intakes were assessed using a validated food frequency questionnaire. Renal net acid excretion (RNAE), an estimate of acid-base balance, was then calculated indirectly from the diet using the formulae of Remer (based on dietary intakes of protein, phosphorus, potassium, and magnesium; RNAERemer) and Frassetto (based on dietary intakes of protein and potassium; RNAEFrassetto), and was energy adjusted by the residual method. After adjusting for potential confounders, multivariable adjusted means of the lumbar spine BMD of women in the highest tertiles of RNAERemer and RNAEFrassetto were significantly lower than those in the lowest tertiles (for RNAERemer: mean difference -0.084 g/cm2; P=0.007 and for RNAEFrassetto: mean difference - 0.088 g/cm2; P=0.004). Similar results were observed in a subgroup analysis of subjects with dietary calcium intake of >800 mg/day. In conclusion, a higher RNAE (i. e. more dietary acidity), which is associated with greater intake of acid-generating foods and lower intake of alkali-generating foods, may be involved in deteriorating the bone health of postmenopausal Iranian women, even in the context of adequate dietary calcium intake.

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