Evaluation of Mars Technique on Patients Suffering From Hypoxic Liver Failure Following Cardiogenic Shock

El‐Banayosy, Aly; Kizner, L.; Noto, M; Cobaugh, D.; Schueler, V.; Bergmeier, Stephen C.; Köerfer, Reiner

doi:10.1097/00002480-200203000-00057

Cited by 4 publications

(8 citation statements)

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“…Six trials met criteria for inclusion 20–25. Of the 4 randomized trials, 3 had been published as full manuscripts in peer‐reviewed journals20, 21, 23 and 1 was published only in an abstract form 22. These trials formed the basis of primary analyses.…”

Section: Resultsmentioning

confidence: 99%

“…The 4 randomized trials included 67 patients; 36(53.7%) had received MARS treatment, and 31 (42 (35.3%) had received standard medical treatment (Table 1). 20–23 Of these, 2 trials included 37 patients with AOCLF 20, 21. In 1 of these trials, patients of AOCLF with type 1 hepatorenal syndrome were included.…”

Section: Resultsmentioning

confidence: 99%

“…The etiology of hepatic cirrhosis in these patients was alcohol in 26, hepatitis viruses in 5, drugs in 2, Budd Chiari syndrome in 1, and biliary cirrhosis in 3. Another 2 trials included 30 patients with ALF 22, 23. The etiology of ALF was acetaminophen in 10 patients, cardiogenic shock in 17, and hepatitis B in 2, and disulfiram in 1 patient.…”

Section: Resultsmentioning

confidence: 99%

“…Data on bridge‐to‐transplantation23 and effect on hepatic encephalopathy21 were reported in 1 trial each only. The registration of adverse events associated with standard medical therapy was incomplete in all except 1 trial 22. Thus, we were able to perform meta‐analysis on all‐cause‐deaths only.…”

Section: Resultsmentioning

confidence: 99%

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Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

2004

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Molecular adsorbent recirculating system (MARS) is an important option for patients with liver failure to give them additional time for recovery or to serve as a "bridge" to transplantation. However, its effect on survival for such patients is not well known. Our aim was to assess the treatment effects of MARS on patients with acute and acute-on-chronic liver failure. The outcomes measure evaluated was survival. We searched Medline (1966 -2002) and EMBASE (1974 -2002) using the terms liver failure, liver support systems, and MARS. Our search was extended to the Cochrane Controlled Trials Registry Database, published abstracts from 5 international conferences, Teraklin (the manufacturer of MARS), known contacts, and bibliographies from each full-published report. We included trials published in English and nonEnglish languages. Eligible studies were randomized and nonrandomized controlled trials, which compared the treatment effects of MARS with standard medical treatment. Of the 206 articles screened, 4 randomized controlled trials including 67 patients were analyzed. Two nonrandomized trials with 61 patients were used for explorative analysis. The methodology, population, intervention, and outcomes of each selected trial were evaluated by duplicate independent review. Disagreements were resolved by consensus. In the primary meta-analysis, MARS treatment did not appear to reduce mortality significantly compared with standard medical treatment [relative risk (RR), 0.56; 95% confidence interval (CI), 0.28 -1.14; P ‫؍‬ .11]. Only 1 of the 4 randomized trials analyzed showed significant reduction in mortality. Sensitivity analysis of 3 peer-reviewed trials did not reduce mortality significantly with MARS treatment (RR, 0.72; 95% CI, 0.37 -1.40; P ‫؍‬ .33). Subgroup analysis of 2 trials for acute liver failure and another 2 trails for acute-onchronic liver failure also did not reveal any benefit to survival with MARS treatment. In contrast, explorative analysis of 2 nonrandomized trials showed a significant survival benefit with MARS treatment (RR, 0.36; 95% CI, 0.17 -0.76; P ‫؍‬ .007). This was possibly related to bias in the selection of patients in the nonrandomized trials. In conclusion, MARS treatment had no significant survival benefit on patients with liver failure when compared with standard medical therapy. However, we found only a few trials with a small number of patients for the analysis, allowing for the possibility of false negative and erroneous conclusions. Well-conducted randomized trials are strongly recommended to define the role of MARS in the treatment of patients with liver failure. (Liver Transpl

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

2004

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“…Unfortunately, the answer to this question remains elusive. A meta-analysis of four randomized controlled trials concluded that treatment with MARS provided no survival benefit [13][14][15][16][17]. In one of these trials, a survival benefit for ALF was shown in a preliminary abstract [13], but lost in the subsequent larger publication [18].…”

Section: Molecular Adsorbents Recirculating Systemmentioning

confidence: 99%

Liver support devices

Phua

Lee

2008

Current Opinion in Critical Care

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Enthusiasm in liver support devices is justified as many nonrandomized studies have suggested some biochemical and clinical benefits. The results of several ongoing multicenter randomized controlled trials are anxiously awaited. Meanwhile, because mortality without liver transplantation remains high despite the use of liver support devices, these devices should only be used in the research setting or by experts proficient in their use and as a bridge to liver transplantation rather than liver recovery.

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Large-scale implementation of a critical care surge capacity management program

Lawless

Trpkovski²

2010

Critical Care

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IntroductionWe previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, however, improving neurological function. The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2]. Carbamylated EPO (cEPO) is an EPO derivative without erythropoietic activity and devoid of the EPO side eff ects, but with apparently well maintained cytoprotective qualities [3]. We therefore tested the hypothesis whether cEPO may be equally effi cient as EPO in reducing morphological as well as functional aortic occlusion-induced spinal cord I/R injury. Methods In a randomized and blinded trial pigs received either vehicle (control, n = 9), EPO or cEPO, respectively (n = 9 each; 5,000 IU/kg over 30 minutes before and during the fi rst 4 hours of reperfusion). Animals underwent 30 minutes of thoracic aortic balloon occlusion with catheters placed immediately downstream of the A. subclavia and upstream of the aortic trifurcation. Spinal cord function was assessed by motor evoked potentials (MEP as percentage of the amplitude before aortic occlusion) and lower limb refl exes (assessed as the subjective strength of response) for a period of 10 hours after reperfusion. Tissue damage was evaluated using Nissl staining. Results Both EPO-treated and cEPO-treated animals presented with attenuated spinal cord injury in the Nissl staining (median (quartile) percentage of damaged neurons in the thoracic segments: control 27 (25,44), cEPO 8 (4,10), and EPO 5 (5,7), P <0.001 vs control group; in the lumbar segments: control 26 (19,32), cEPO 7 (5,13), EPO 8 (5,10), P <0.001 vs control group). However, while only cEPO treatment was associated with recovery of the MEP amplitude to pre-occlusion values when compared with the control group (P <0.05), lower limb refl ex response was comparably restored stronger in both treatment groups (P <0.05 vs control). Conclusions In a clinically relevant porcine model mimicking aortic crossclamping during vascular surgery repair of thoracic aortic aneurysm, cEPO protected spinal cord function and integrity as eff ective as EPO when applied at equipotent doses. Acknowledgements Supported by the Deutsche Forschungs gemeinschaft (SCHE 899/2-2). References Introduction Unfolded protein response (UPR)-mediated apoptosis plays a pivotal role in ischemia-reperfusion injury. Sodium 4-phenylbutyrate (PBA) has been reported to act as a chemical chaperone inhibiting UPR-mediated apoptosis triggered by ischemia in various organs other than the heart. Therefore we investigated whether PBA reduces UPR-mediated apoptosis and protects against myocardial ischemia-reperfusion injury in mice. Methods C57BL/6 mice were subjected to 30 minutes LAD ischemia followed by reperfusion. PBA (100 mg/kg) or PBS (control) was administrated intraperitoneally just before ischemia. Apoptosis, infarct ...

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Evaluation of Mars Technique on Patients Suffering From Hypoxic Liver Failure Following Cardiogenic Shock

Cited by 4 publications

References 0 publications

Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

Molecular adsorbent recirculating system for acute and acute-on-chronic liver failure: A meta-analysis

Liver support devices

Large-scale implementation of a critical care surge capacity management program

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