Extra-Corporeal Systems in Acute Liver Failure: Pro perspective

Speakers: Ram Subramanian, Emory University Hospital, Atlanta, US. Florent Artru, Clinical Research Fellow - King's College Hospital, London, UK

Florent Artru: Hello, I'm Florent Artru from King's College Hospital London. On behalf of the ILTS Acute Liver Failure Special Interest Group Steering Committee, it's my pleasure to introduce this short video focusing on an emerging field in the management of acute liver failure, which is the use of extracorporeal systems. According to a large international survey launched last year, we have observed a wide heterogeneity of use of these devices worldwide ranging from 20% in Latin America to almost 90 to 100% in Australia and New Zealand. And this, despite emerging evidences regarding the potential benefit of ECLS in the field of acute liver failure, three experts from our group have summarized their opinion for and against the use of the ECLS. We hope that this video will encourage you to better explore the field and eventually participate in future research projects eventually participate in future research projects. Do not hesitate to interact on social media with this video and also with our group.

Ram Subramanian: Hello everyone. I'm Ram Subramanian and I'm an intensivist and hepatologist at Emory University in Atlanta. Regarding my views on the use of the ECLS systems in ALF I think there are two specific modalities that, in my opinion, have an increasing role in the application of the sick ALF patient. Number one is high dose CRRT which is very effective in treating the metabolic acidosis and the hyperammonemia in order to prevent intracranial hypertension. Number two is the utility of plasma exchange with FFP which in our experience has been shown to really favorably influence the treatment of severe shock in these patients, which could have implications regarding hepatic stabilization and extrahepatic stabilization.

Ram Subramanian: So when I think about the potential obstacles to the application of ECLS systems in ALF, I think the main issue may be awareness regarding the efficacy of high dose CRRT and plasma exchange with FFP in the setting of ALF. So I think an important measure would be to share with the scientific community in a broader context of how high-dose CRRT and plasma exchange can be helpful in patients with severe ALF. The second point I'd like to make is the consideration and awareness of applying high-dose CRRT and plasma exchange simultaneously. We've actually done this, especially in younger patients who can tolerate two extracorporeal systems, with great efficacy because, in my opinion, those could be synergistic where the CRRT can address the hyper ammonaemia and metabolic acidosis issues while plasma exchange could provide the hemodynamic benefit with respect to improving shock.