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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome
  1. Lakshmi Kumar Dr1,
  2. Dinesh Balakrishnan2,
  3. Rekha Varghese1,
  4. Sudhindran Surendran2
  1. 1Department of Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Cochin, India
  2. 2Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
  1. Correspondence to Prof Lakshmi Kumar Dr, lakshmi.k.238{at}gmail.com

Summary

Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO2 is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO2 of 37 mm Hg on room air and underwent living donor liver transplant. Although stable intraoperatively, he desaturated on the second postoperative day. Despite a number of interventions, oxygenation remained critically low on 100% inspired oxygen. Extracorporeal membrane oxygenator (ECMO) was established with instant improvement in oxygenation (PaO268 mm Hg), and the patient was eventually salvaged. We suggest that ECMO could be a means of managing refractory post-transplant hypoxaemia in patients with HPS.

  • Cirrhosis
  • Adult Intensive Care

https://doi.org/10.1136/bcr-2017-221381

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    Footnotes

    • Contributors LK clinically associated, researched and wrote the manuscript. DB clinically involved and contributed to the successful management of the case. RV assisted in patient management and reviewed manuscript. SS supervised and was involved in case management and contributed to the writing of manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.