J.Jpn. Surg. Soc.. 78(2): 176-195, 1977

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Original article

EXPERIMENTAL AND CLINICAL STUDY OF TOTAL BODY WASHOUT EMPLOYING EXTRACORPOREAL CIRCULATION AND HYPOTHERMIA FOR THE TREATMENT OF ACUTE HEPATIC FAILURE

Total body washout was evaluated in dogs. The body temperature was cooled to 24 ℃ by extracorporeal circulation and the animals were then exsanguinated. Cold lactated Ringer's solution was perfused into the artery until hematocrit fell to 0.1% while venous return was freely drained and discarded. Rewarming extracorporeal circulation using fresh homologous blood completed the procedure.
Three groups of the animals of six each were studied. In group I animals (control) underwent TBW only. The animals in group II received lethal doses of pentobarbital sodium prior to TBW.
Plasma barbiturate levels were reduced from 13.1 to 2.6 mg%, a clearance rate of 78.3% after TBW. Group III dogs with jaundice were treated with TBW. Serum bilirubin levels fell 6.7 to 0.5 mg%, a clearance rate of 91.6% .
TBW was then employed in two clinical cases. In the first case the procedure was carried out suecessfully, however the patient expired from massive gastrointestinal bleeding without any evidence of the recovery of consciousness. The second patient regained his full consciousness immediately after the treatment and could speak correctly. However, he expired from exsauinating bleeding esophageal varices on 8th postoperative day.
The details of the procedure, laboratory and pathological findings were discussed.

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