Modular extracorporeal life support for multiorgan failure patients

Area of Science:

• Critical Care Medicine
• Hepatology
• Cardiopulmonary Support

Background:

• Adults on respiratory Extracorporeal Membrane Oxygenation (ECMO) exhibit a 66% survival rate.
• Multisystem Organ Failure (MSOF) is a common complication in non-survivors, with hepatic failure often preceding death.
• Serum bilirubin levels exceeding 300 micromol/l in ECMO patients strongly predict mortality.

Purpose of the Study:

• To evaluate the efficacy of the Molecular Adsorbent Recirculating System (MARS) in improving survival for adult respiratory ECMO patients experiencing MSOF with liver failure.
• To assess the impact of MARS treatment on serum bilirubin levels in this patient cohort.

Main Methods:

• MARS, a liver support device, was administered to five adult patients (aged 19-56) with respiratory ECMO-induced liver failure.
• Patients received 1 to 8 MARS treatments.
• Serum bilirubin levels were monitored before and after treatment.

Main Results:

• The mean peak bilirubin level was 529 micromol/l (range: 436-750 micromol/l).
• MARS treatment resulted in a mean bilirubin reduction of 30-162 micromol/l per patient.
• Two out of five patients (40%) survived, with survivors demonstrating the most significant bilirubin reduction.

Conclusions:

• Despite severe liver failure, MARS therapy showed potential benefit in improving survival rates for ECMO patients with MSOF.
• The greatest bilirubin reduction correlated with patient survival, suggesting MARS's therapeutic role.
• MARS may offer a viable treatment option for MSOF in critically ill respiratory ECMO patients.