You can manage bookmarks using lists, please log in to your user account for this.
Media type:
E-Article
Title:
Cardiac arrest associated with reperfusion of the liver during transplantation: incidence and proposal for a management algorithm
Contributor:
Aufhauser, David D.;
Rose, Tom;
Levine, Matthew;
Barnett, Rebecca;
Ochroch, E. Andrew;
Aukburg, Stanley;
Greenblatt, Eric;
Olthoff, Kim;
Shaked, Abraham;
Abt, Peter
imprint:
Wiley, 2013
Published in:Clinical Transplantation
Language:
English
DOI:
10.1111/ctr.12052
ISSN:
0902-0063;
1399-0012
Origination:
Footnote:
Description:
<jats:title>Abstract</jats:title><jats:p>Cardiac arrest associated with reperfusion of the liver allograft in a euvolemic patient is a rare but potentially devastating event. There are few case series describing experience with this complication and no published management protocols guiding treatment. This article is a retrospective case series of patients experiencing post‐reperfusion intraoperative cardiac arrest between 1997 and 2011. Among 1581 liver transplants, 16 (1%) patients experienced post‐reperfusion cardiac arrest. Among patients with intraoperative arrests, 14 (88%) patients required open cardiac massage. Seven (44%) were placed on cardiopulmonary bypass (<jats:styled-content style="fixed-case">CPB</jats:styled-content>) when cardiac activity failed to adequately recover. Placement on <jats:styled-content style="fixed-case">CPB</jats:styled-content> reversed cardiac pump failure and established a perfusing rhythm in six of seven (86%) recipients, leading to one of seven (14%) intraoperative mortality. Recovery of myocardial function was associated with low early survival with only 3/7 (43%) patients who underwent <jats:styled-content style="fixed-case">CPB</jats:styled-content> surviving until discharge. Among all patients who survived the perioperative period, one‐yr survival was 70% (N = 7), and five‐yr survival was 50% (N = 5). Cardiac arrest during liver transplantation is associated with a poor prognosis during the perioperative period. In patients who do not recover cardiac activity after standard resuscitative measures, progression to physiologic support with systemic anticoagulation and <jats:styled-content style="fixed-case">CPB</jats:styled-content> may allow correction of electrolyte derangements, maintenance of cerebral perfusion, and myocardial recovery.</jats:p>