Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosis

Viana, José Antônio; Furtado, Emanuel; Romero, A. Lázaro; Furtado, A.

doi:10.1016/s0041-1345(03)00336-1

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…One RCT,41 2 NR‐OBS trials,46, 47 and 2 CSs50, 51 reported the deleterious effects of VVBP (26%, 10%‐30%, 20%, 2.2%, and 1.6% of patients, respectively). All these studies reported complications that were related to the placement of intravenous cannulas (nerve injuries, hematomas, catheter misplacement, and death) and other complications (thrombosis, low flow rates, and cardiovascular events).…”

Section: Resultsmentioning

confidence: 99%

“…All these studies reported complications that were related to the placement of intravenous cannulas (nerve injuries, hematomas, catheter misplacement, and death) and other complications (thrombosis, low flow rates, and cardiovascular events). Two NR‐OBS studies described pulmonary thromboembolisms (PTEs),46, 47 and air embolisms (AEs) were reported in 3 studies 46, 49, 50…”

Section: Resultsmentioning

confidence: 99%

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Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries

Rando¹,

Niemann

Taurà

et al. 2011

Liver Transpl

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Although liver transplantation (LT) is a highly effective treatment, it has been considered too costly for publicly funded health systems in many countries with low to medium average incomes. However, with economic growth and improving results, some governments are reconsidering this position. Cost-effectiveness data for LT are limited, especially in perioperative care, and the techniques and costs vary widely between centers without overt differences in outcomes. Anesthesiologists working in new programs find it difficult to determine which modalities are essential, which are needed only in exceptional circumstances, and which may be omitted without effects on outcomes. We investigated key elements of preoperative evaluations, intraoperative management, and early postoperative care that might significantly affect costs in order to develop a best-value approach for new programs in resource-limited health systems. We identified all modalities of care commonly used in anesthesia and perioperative care for adult LT along with their costs. Those considered to be universally accepted as minimum requirements for safe care were excluded from the analysis, and so were those considered to be safe and lowcost, even when evidence of efficacy was lacking. The remaining items were, therefore, those with uncertain or context-restricted value and significant costs. A systematic review of the published evidence, practice surveys, and institutional guidelines was performed, and the evidence was graded and summarized. With respect to costs and benefits, each modality was then cited as strongly recommended, recommended or optional, or no recommendation was made because of insufficient

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries

Rando¹,

Niemann

Taurà

et al. 2011

Liver Transpl

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“…Wolf et al demonstrated that before transplantation, one‐third of donor livers contain intrahepatic air, whereas Liu et al showed that embolisms occur largely as a result of the routine handling of donor organs. Air can be actively perfused into the donor organ's vasculature during the delivery of the cold flush at the time of procurement, during a venovenous bypass, and, as machine perfusion (MP) gains popularity, at the time of the connection and during dynamic donor organ preservation . The passive introduction of air can occur when subatmospheric pressures are generated in the vasculature, such as when the organ is suspended above the fluid line and drained, the vasculature is perforated, or air is encapsulated during an anastomosis .…”

mentioning

confidence: 99%

Effects of air embolism size and location on porcine hepatic microcirculation in machine perfusion

et al. 2014

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The handling of donor organs frequently introduces air into the microvasculature, but little is known about the extent of the damage caused as a function of the embolism size and distribution. Here we introduced embolisms of different sizes into the portal vein, the hepatic artery, or both during the flushing stage of porcine liver procurement. The outcomes were evaluated during 3 hours of machine perfusion and were compared to the outcomes of livers with no embolisms. Dynamic contrast-enhanced ultrasound (DCEUS) was used to assess the perfusion quality, and it demonstrated that embolisms tended to flow mostly into the left lobe, occasionally into the right lobe, and rarely into the caudate lobe. Major embolisms could disrupt the flow entirely, whereas minor embolisms resulted in reduced or heterogeneous flow. Embolisms occasionally migrated to different regions of the same lobe and, regardless of their size, caused a general deterioration in the flow over time. Histological damage resulted primarily when both vessels of the liver were compromised, whereas bile production was diminished in livers that had arterial embolisms. Air embolisms produced a dose-dependent increase in vascular resistance and a decline in oxygen consumption. This is the first article to quantify the impact of air embolisms on microcirculation in an experimental model, and it demonstrates that air embolisms have the capacity to degrade the integrity of donor organs. The extent of organ damage is strongly dependent on the size and distribution of air embolisms. The diagnosis of embolism severity can be safely and easily made with DCEUS. Liver Transpl 20:601-611, 2014. V C 2014 AASLD.Received October 12, 2013; accepted January 5, 2014.Air embolisms in donor organs are a well-known occurrence. Wolf et al. 1 demonstrated that before transplantation, one-third of donor livers contain intrahepatic air, whereas Liu et al. 2 showed that embolisms occur largely as a result of the routine handling of donor organs. Air can be actively perfused into the donor organ's vasculature during the delivery of the cold flush at the time of procurement, 3,4 during a venovenous bypass, 5-7 and, as machine perfusion (MP) gains popularity, at the time of the connection and during dynamic donor organ preservation. 8 The passive introduction of air can occur when subatmospheric pressures are generated in the vasculature, such as when the organ is suspended above the fluid line and drained, the vasculature is perforated, or air is encapsulated during an anastomosis.2,4,9 Air embolisms are Abbreviations: ALT, alanine aminotransferase; CL, caudate lobe; DCEUS, dynamic contrast-enhanced ultrasound; HA, hepatic artery; LLL, left lateral lobe; LML, left medial lobe; MP, machine perfusion; PV, portal vein.

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Postoperative Care of the Liver-Transplant Patient

Berry¹,

Melendez²,

Wendon³

2010

Surgical Intensive Care Medicine

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Air embolism as a complication of venovenous bypass during liver transplant for diffuse hemangiomatosis

Cited by 5 publications

References 4 publications

Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries

Optimizing cost-effectiveness in perioperative care for liver transplantation: A model for low- to medium-income countries

Effects of air embolism size and location on porcine hepatic microcirculation in machine perfusion

Postoperative Care of the Liver-Transplant Patient

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