Extracorporeal Liver Support with Dr. Ayse Akcan Arikan -- Part 1
Jun 10, 2024
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Dr. Ayse Akcan Arikan, a pediatric intensivist and nephrologist, discusses extracorporeal liver support in acute liver failure. Topics include modalities of liver support, innovative therapy implementation, managing liver failure in pediatric patients, and the use of extracorporeal therapies like SPAD, MARS, and CRRT.
Extracorporeal liver support modalities like SPAD, MARS crucial for acute liver failure patients.
Dr. Arikan's expertise in pediatric extracorporeal therapies emphasizes innovation and comprehensive patient care.
Deep dives
Overview of Extracorporeal Liver Support
Extracorporeal liver support involves various modalities like SPAD, MARS, CRRT, and TPE to manage acute kidney injury, multi-organ failure, and sepsis. These therapies are crucial for patients, especially those with acute liver failure, as they help in optimizing organ support beyond what conventional treatments provide.
Dr. Aisha Arikan's Pathway to Dual Training
Dr. Aisha Arikan, a pediatric intensivist and nephrologist, explains her unexpected journey into dual training. Initially drawn to critical care, she delved deeper into nephrology, leading to a unique expertise in extracorporeal therapies like CRRT and ECMO, reflecting her passion for innovative medical interventions.
Importance of Extracorporeal Liver Support in Liver Failure Patients
In liver transplant centers like Texas Children's Hospital, extracorporeal liver support plays a crucial role in treating patients with acute liver failure and hepatic encephalopathy. Combining CRRT and TPE with innovative treatments like MARS offers a comprehensive approach to managing critical liver failure and improving patient outcomes.
Challenges and Risks in Extracorporeal Therapies
The complexity of extracorporeal therapies presents challenges in pediatric patients, especially concerning access and coagulopathy management. Balancing anticoagulation, citrate toxicity, and concerns like delusional coagulopathy in Mars treatments require meticulous monitoring and expertise to ensure optimal patient care.
Ayse Akcan Arikan, MD is a dual trained pediatric intensivist and nephrologist and an Associate Professor of Pediatrics with tenure at Baylor College of Medicine. She is the Associate Chief (Research) of the Division of Critical Care Medicine. Dr Arikan is a clinician-scientist whose research focus is on the recognition and management of acute kidney injury in the critically ill, pharmacokinetics in extracorporeal therapies, management of multiple organ failure, as well as sepsis resuscitation and outcomes. Dr Arikan also serves as the Medical Director of the Critical Care Nephrology and Inpatient Dialysis and the Medical Director of the Extracorporeal Liver Support programs at Texas Children’s Hospital. She is an international leader in pediatric extracorporeal renal and liver support.
Learning Objectives:
By the end of this podcast, listeners should be able to discuss:
The rationale for using extracorporeal liver support in patients with acute liver failure.
The various modalities of extracorporeal liver support and their advantages and disadvantages.
An expert’s approach to utilization of extracorporeal liver support in patients with acute liver failure.
References:
Akcan Arikan, Ayse MD1,2; Srivaths, Poyyapakkam MD1; Himes, Ryan W. MD3; Tufan Pekkucuksen, Naile MD1; Lam, Fong MD2; Nguyen, Trung MD2; Miloh, Tamir MD3; Braun, Michael MD1; Goss, John MD4; Desai, Moreshwar S. MD2. Hybrid Extracorporeal Therapies as a Bridge to Pediatric Liver Transplantation*. Pediatric Critical Care Medicine 19(7):p e342-e349, July 2018. | DOI: 10.1097/PCC.0000000000001546
Mitzner SR. Extracorporeal liver support-albumin dialysis with the Molecular Adsorbent Recirculating System (MARS). Ann Hepatol. 2011 May;10 Suppl 1:S21-8. PMID: 21566251.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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