New onset atrial fibrillation during orthotopic liver transplantation induced by iced saline injection for transpulmonary thermodilution: a case report

Abstract

Transpulmonary thermodilution is often used to measure extravascular lung water during liver transplantation. Here, the case of new onset atrial fibrillation during orthotopic liver transplantation, which may have been induced by iced saline injection for transpulmonary thermodilution measurement, is described. A 52-year-old male patient underwent orthotopic liver transplantation due to alcoholic cirrhosis combined with portal hypertension. During dissection of the recipient liver, transpulmonary thermodilution was performed. At 3 minutes following iced saline injected, atrial fibrillation occurred, the ventricular rate increased to more than 120 beats per min, and blood pressure dropped to 75/50 mmHg. Massive haemorrhage, inferior vena cava clamping, electrolyte disorder, acid-base balance disorder, and hypothermia were all ruled out, and iced saline injection was suspended. Hemodynamic stability was maintained with phenylephrine and lanatocide C (cedilanid), and chemical cardioversion was performed using amiodarone. During the reperfusion phase, transient hemodynamic instability was managed by norepinephrine. The neohepatic phase was uneventful. Atrial fibrillation lasted for 5 days and reversed to sinus rhythm automatically. The patient was hemodynamically stable during this period, and recovery was smooth with no thromboembolic events. In conclusion, atrial fibrillation may be induced by iced saline injection for transpulmonary thermodilution measurement during orthotopic liver transplantation.

Hemodynamic monitoring in liver transplantation ‘the hemodynamic system’

“…Prolonged hypotension is associated with impaired perfusion of vital organs and vital organ injury [11,18,25,32,85]. HDI in liver transplantation is multifactorial and can be caused by massive fluid shifts, clamping, and unclamping of the inferior vena cava, surgical bleeding, coagulopathy, myocardial dysfunction, dynamic left ventricular outflow tract obstruction (LVOTO), severe vasodilation, and postreperfusion syndrome (PRS) [1 63,66,67,74]. The prevalence of cirrhotic cardiomyopathy (CCM) ranges from 17.5 to 78.6% according to which diagnostic criteria are used [14].…”