The role of MARS in the therapy of liver failure after resuscitated cardiac arrest. Case report

Liliana Colar, Gr. Tinică, A. Ciucu, A. Covic, V. Diaconescu, D. Dăscălescu
Clinica de Chirurgie Cardiovasculară, Centrul de Cardiologie Iaşi

Abstract

Cardiogenic shock with multiple organ dysfunctions has one of the worst prognosis in clinical pathology. In this context, liver failure is associated with increased mortality. MARS is a supportive tool of liver function used in the treatment of acute liver failure.
We report the case of a 53 years old patient with angina (crescendo type), triple vessel disease and left main, submitted for surgical myocardial revascularization by coronary artery by-pass grapht. During placement of skin sutures, ventricular fibrillation occurred (one of the supposed explanation being hypokaliemia).Cardiac resuscitation was started, the extracorporeal circulation reinstalled and the patency of the grapht was checked (no obstruction). Post-resuscitation the patient was transferred in the ICU where he developed low cardiac output syndrome, liver failure (of hypoxic origin) and renal failure. The inten-sive care of the patient included mechanical ventilation, haemodynamic support with vasoactive and inotropic drugs, hemofiltration and as an ultimate therapy of the hepatic failure application of MARS therapy. After 3 MARS applications the patient’s haemodymanics was stabilized and the liver functions were restored. This case report demonstrates that the application of MARS in the treatment of acute hypoxic liver failure was efficient, as the patient survived with good functional condition.

Key words: acute hepatic failure, MARS

CAZ CLINIC

Utilizarea tehnicii MARS (Molecular Adsorbents Recycling System) în tratamentul insuficienţei hepatice acute după un stop cardiac resuscitat. Prezentare de caz

Jurnalul Român de Anestezie Terapie intensivă 2007 Vol.14 Nr.1, 57-61