N. Dobrilovic1, L. Michalak1, O. Lateef2, B. Mohamedali2, D. Smego1, R. March1, M. Alimohamed2, M. Delibasic1, D. Radovanovic1, J. R. Raman1 1Rush University Medical Center,Cardiovascular And Thoracic Surgery,Chicago, IL, USA 2Rush University Medical Center,Internal Medicine,Chicago, IL, USA
INTRODUCTION
Extracorporeal membrane oxygenation (ECMO) support can provide critically ill patients an opportunity to survive otherwise lethal illness. With roughly half of patients surviving ECMO, it remains unclear how and when to apply this labor-intensive, costly resource. Clear predictors of outcomes have yet to be defined. We examine the role of liver dysfunction in adult ECMO patients as a potential prognostic marker.
METHODS
This study reports a five-year, retrospective, single institution experience examining all adult patients for whom ECMO support was utilized. Trends in liver function were examined (albumin, PT-INR, total bilirubin, AST, and ALT).
RESULTS
A database of 105 ECMO patients was reviewed, and all adult patients (n=66) were included. Mean age was 53 (range 19-82) years, 35 male, 31 female. Fifty-three percent (35/66) of adult patients met at least one criterion for liver dysfunction. Mean duration of ECMO support was 8 days. Overall hospital mortality was 68% (45/66).
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CONCLUSION
Increases in total bilirubin, ALT, and AST levels all correlated with early mortality despite good cardio-pulmonary support. Profound liver dysfunction in patients supported with ECMO is a poor prognostic sign associated with exceedingly high mortality. It is expected that liver function studies will play a significant role in patient selection criteria regarding 1) initiation of ECMO, 2) as a criterion for termination of ECMO, and 3) possibly as a trigger for use of liver support devices.
