Setting the Scene: Extracorporeal Life Support Organisation (ELSO) Registry Data on the Provision of ECLS for Liver Transplant Recipients

TY - JOUR

T1 - Setting the Scene: Extracorporeal Life Support Organisation (ELSO) Registry Data on the Provision of ECLS for Liver Transplant Recipients

AU - Saha, R

AU - Patel, S

AU - Rycus, P

AU - Willars, C

AU - McPhail, M

AU - Auzinger, G

AU - Loveridge, R

PY - 2017/5

Y1 - 2017/5

N2 - Introduction/Aim: This study describes outcomes, trends in extracorporeal membrane oxygenation (ECMO), and complications for liver transplant recipients who required ECMO. Methods: Using data reported to the ELSO registry since 1989, patients assigned a CPT code of 47135 (corresponding to liver transplantation) were extracted. Variables included demographics, diagnoses, pre-ECMO and ECMO details, complications and outcomes. Results: Between 1989 and 2016, 156 ECMO runs were reported in patients with a CPT code of 47135. 109/156 (69.9%) were over 10 years old and 47 in younger children-68.8% cases occurred post-2012. Median age was 53.5 years with veno-arterial (VA) ECMO in 56% and veno-venous (VV) ECMO in 44% and pre-ECLS arrest occurred in 34%. 30/109 (28%) patients survived to hospital discharge, although ECMO survival was 50%. Pre-ECMO systolic and mean arterial blood pressure, PaCO2 and serum bicarbonate were significantly higher in survivors while peak inspiratory pressure at 24 hours was significantly lower. DIC and hyperbilirubinemia (>2mg/dl direct or 15 mg/dl total) were associated with mortality. Age, sex, weight, mode of ECMO support, cardiac arrest, time to initiation and primary diagnosis were not associated with mortality. Conclusion: We report on the limited use of ECMO in liver transplant recipients. Survival in this cohort does not suggest futility especially with careful patient selection. We found that survival was influenced predominantly by pre-ECMO patient factors. It is unclear how many were managed in specialist liver failure and transplant centres and whether this would affect outcomes. We need to find a way to benchmark risk adjusted outcomes for complex populations requiring ECLS.

AB - Introduction/Aim: This study describes outcomes, trends in extracorporeal membrane oxygenation (ECMO), and complications for liver transplant recipients who required ECMO. Methods: Using data reported to the ELSO registry since 1989, patients assigned a CPT code of 47135 (corresponding to liver transplantation) were extracted. Variables included demographics, diagnoses, pre-ECMO and ECMO details, complications and outcomes. Results: Between 1989 and 2016, 156 ECMO runs were reported in patients with a CPT code of 47135. 109/156 (69.9%) were over 10 years old and 47 in younger children-68.8% cases occurred post-2012. Median age was 53.5 years with veno-arterial (VA) ECMO in 56% and veno-venous (VV) ECMO in 44% and pre-ECLS arrest occurred in 34%. 30/109 (28%) patients survived to hospital discharge, although ECMO survival was 50%. Pre-ECMO systolic and mean arterial blood pressure, PaCO2 and serum bicarbonate were significantly higher in survivors while peak inspiratory pressure at 24 hours was significantly lower. DIC and hyperbilirubinemia (>2mg/dl direct or 15 mg/dl total) were associated with mortality. Age, sex, weight, mode of ECMO support, cardiac arrest, time to initiation and primary diagnosis were not associated with mortality. Conclusion: We report on the limited use of ECMO in liver transplant recipients. Survival in this cohort does not suggest futility especially with careful patient selection. We found that survival was influenced predominantly by pre-ECMO patient factors. It is unclear how many were managed in specialist liver failure and transplant centres and whether this would affect outcomes. We need to find a way to benchmark risk adjusted outcomes for complex populations requiring ECLS.

KW - adult arterial carbon dioxide tension bicarbonate

U2 - 10.1002/ejhf.869

DO - 10.1002/ejhf.869

M3 - Meeting Abstract

SN - 1388-9842

VL - 19

SP - 41

JO - EUROPEAN JOURNAL OF HEART FAILURE

JF - EUROPEAN JOURNAL OF HEART FAILURE

IS - Suppl. 2

ER -