Tigano Stefano, Casolaro Giulio, Bianchini Amedeo, Bernardi Enrico, Laici Cristiana, Ramahi Linda, Vitale Giovanni, Siniscalchi Antonio
Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Università di Bologna, 40126 Bologna, Italy.
Medicina (Kaunas). 2025 Apr 21;61(4):768. doi: 10.3390/medicina61040768.
: Indications for liver transplants are increasing worldwide due to the growing number of transplants performed on patients with significant cardiovascular and respiratory risk factors. Additional support for this trend comes from the growing use of marginal organs, which is made possible by donations made after circulatory death (DCD). Liver transplantation (LT) in such high-risk patients may be challenging and may require perioperative Extracorporeal Membrane Oxygenation (ECMO). There is a lack of evidence on the best hemodynamic monitoring techniques for patients undergoing ECMO support during the perioperative period of LT. This review aims to provide a comprehensive overview of the hemodynamic monitoring standards of patients supported by ECMO before, during, and after LT. : Comprehensive research was conducted through the PubMed database, and 153 articles regarding patients who needed perioperative ECMO support were found. Among these, 18 articles were finally included in our analysis as the authors specified hemodynamic monitoring techniques and data. The articles included case reports, letters to the editor, and correspondence. : We identified 20 cases of patients supported by ECMO as a planned preoperative strategy (9 patients), as a rescue therapy during surgery (7 patients), and as a postoperative support (4 patients). Cardiac catheterism and echocardiography (transthoracic and transesophageal) were the authors' most cited hemodynamic monitoring techniques. : Data on hemodynamic monitoring methods used to manage patients supported by ECMO during the whole perioperative period of LT are poor and derived from descriptive low-quality studies. However, a multimodal approach that includes continuous monitoring of pulmonary pressures and echocardiography can increase diagnostic accuracy and improve the decision-making process to manage this complex patient population.
由于对患有重大心血管和呼吸风险因素的患者进行的肝移植手术数量不断增加，全球范围内肝移植的适应症也在增加。对这一趋势的进一步支持来自于边缘器官使用的增加，这得益于循环死亡后捐赠（DCD）。在这类高危患者中进行肝移植（LT）可能具有挑战性，可能需要围手术期体外膜肺氧合（ECMO）。对于在肝移植围手术期接受ECMO支持的患者，缺乏关于最佳血流动力学监测技术的证据。本综述旨在全面概述肝移植术前、术中和术后接受ECMO支持的患者的血流动力学监测标准。：通过PubMed数据库进行了全面研究，发现了153篇关于需要围手术期ECMO支持的患者的文章。其中，18篇文章最终被纳入我们的分析，因为作者明确了血流动力学监测技术和数据。这些文章包括病例报告、给编辑的信和通信。：我们确定了20例接受ECMO支持的患者，作为术前计划策略（9例）、手术期间的抢救治疗（7例）和术后支持（4例）。心导管检查和超声心动图（经胸和经食管）是作者引用最多的血流动力学监测技术。：关于在肝移植整个围手术期用于管理接受ECMO支持的患者的血流动力学监测方法的数据很少，且来自描述性的低质量研究。然而，一种包括持续监测肺压力和超声心动图的多模式方法可以提高诊断准确性，并改善管理这一复杂患者群体的决策过程。
