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Louisiana State University Health Sciences Center |
Critical Care Medicine |
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| Liver Support |
Extracorporeal Life Support (ECLS) denotes a family of therapies for severe cardiopulmonary failure that includes extracorporeal membrane oxygenation (ECMO) and related support therapies. The ECLS program at LSUHSC covers all extracorporeal therapies provided in the ICU, including:
ECMO (extracorporeal membrane oxygenation)
CRRT (continuous renal replacement therapies)
TPE (therapeutic plasma exchange)
Liver support for acute hepatic failure
ECMO is an advanced procedure in which a form of prolonged cardiopulmonary bypass is used in the ICU to support patients with severe life-threatening cardiac or pulmonary failure that does not respond to conventional therapies. About 125 centers in the US and Europe offer ECMO to neonatal and pediatric patients, and only about 20 of these provide ECMO to adult patients. LSUHSC is proud to be one of these advanced centers offering ECMO to patients of all ages.
Conventional therapy may include prone positioning, high frequency ventilation (oscillatory or jet), inhaled nitric oxide, pulmonary surfactant, and diuresis or hemofiltration.
Continuous renal replacement therapies provide ultrafiltration, hemofiltration, and hemodialysis continuously to critically ill patients. These therapies are better tolerated than traditional intermittent hemodialysis (IHD), provide for better fluid management, and offer higher levels of renal replacement therapy than IHD. They also offer convective clearance for removal of middle molecules that are not removed with IHD. CRRT is now considered the renal replacement therapy of choice in patients with cardiopulmonary compromise.
Plasma exchange is indicated in a number of diseases, but is now receiving attention as part of the treatment of severe sepsis. We reserve TPE in patients with sepsis to those who require hemodynamic support and have persistent, non-resolving lactic acidosis despite optimal therapy for 12 to 24 hours. TPE combined with high volume hemofiltration can provide temporary support for fulminant hepatic failure.
Liver support in acute fulminant hepatic failure involves extracorporeal treatment of the blood to support liver function. Common conditions considered for this therapy include toxin-induced hepatic failure, acute exacerbation of chronic liver failure due to intercurrent illness, and other causes.