48 min
Galvagno & Carpenter – Molecular Adsorbent Recirculating System: Life on MARS. Maryland CC Project
-
- Medicine
@import url('https://fonts.googleapis.com/css?family=Merriweather&display=swap');
p, li, h1, h2, h3, h4 {font-family: 'Merriweather', serif;font-size:18px; color:black;}
Samuel M. Galvagno Jr., DO, PhD, MS, FCCM, Associate Professor of Anesthesiology at the University of Maryland SOM & Associate Director, Maryland Critical Care Network at UMMC and Ross Carpenter, MD, Fellow in Cardiothoracic Anesthesia at the University of Maryland, present the weekly multi-departmental critical care fellows’ lecture on “Molecular Adsorbent Recirculating System: Life on MARS.”
Lecture Summary by Dr. Erik Manninen
Introduction
* Liver transplant is the second most common transplanted organ after kidney. 2.5, tbili>3, pH6mmol/L.* Acute fulminant liver failure in a transplant candidate* Acute on chronic liver failure in a listed transplant candidate* Primary non-functioning post liver transplant and one or more of the following: * listed for re-transplant, * UNOS criteria for PNF* hepatic artery thrombosis* INR.2, lactate >6, and clinically deteriorating* Patients with multiple organ failure on a case to case basis
Other Considerations
* N-acetylcysteine dosing should be doubled while on MARS. Other protein bound drugs also need to have dose adjustment and should be reviewed and your clinical pharmacist can be a big help with your patient while on MARS. * Efficacy of MARS is judged on improving clinical parameters like decreasing dose of vasoactive medicines and improving mental status. * There may be a role of using MARS to speed recovery of patients with acute liver failure as well, which allows earlier hospital discharge and doesn’t tie up a potential organ, which could be transplanted to a patient who truly needs it. * While there are no precise recommendations on the effective timing of initiation of artificial liver support systems they can be helpful in select cases.
References
* Mitzner, Steffen R. “Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS).” Annals of hepatology 10.S1 (2016): 21-28. a href="https://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.
@import url('https://fonts.googleapis.com/css?family=Merriweather&display=swap');
p, li, h1, h2, h3, h4 {font-family: 'Merriweather', serif;font-size:18px; color:black;}
Samuel M. Galvagno Jr., DO, PhD, MS, FCCM, Associate Professor of Anesthesiology at the University of Maryland SOM & Associate Director, Maryland Critical Care Network at UMMC and Ross Carpenter, MD, Fellow in Cardiothoracic Anesthesia at the University of Maryland, present the weekly multi-departmental critical care fellows’ lecture on “Molecular Adsorbent Recirculating System: Life on MARS.”
Lecture Summary by Dr. Erik Manninen
Introduction
* Liver transplant is the second most common transplanted organ after kidney. 2.5, tbili>3, pH6mmol/L.* Acute fulminant liver failure in a transplant candidate* Acute on chronic liver failure in a listed transplant candidate* Primary non-functioning post liver transplant and one or more of the following: * listed for re-transplant, * UNOS criteria for PNF* hepatic artery thrombosis* INR.2, lactate >6, and clinically deteriorating* Patients with multiple organ failure on a case to case basis
Other Considerations
* N-acetylcysteine dosing should be doubled while on MARS. Other protein bound drugs also need to have dose adjustment and should be reviewed and your clinical pharmacist can be a big help with your patient while on MARS. * Efficacy of MARS is judged on improving clinical parameters like decreasing dose of vasoactive medicines and improving mental status. * There may be a role of using MARS to speed recovery of patients with acute liver failure as well, which allows earlier hospital discharge and doesn’t tie up a potential organ, which could be transplanted to a patient who truly needs it. * While there are no precise recommendations on the effective timing of initiation of artificial liver support systems they can be helpful in select cases.
References
* Mitzner, Steffen R. “Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS).” Annals of hepatology 10.S1 (2016): 21-28. a href="https://www-ncbi-nlm-nih-gov.proxy-hs.researchport.umd.
48 min