Equipment review The molecular adsorbents recirculating system (MARS？).docVIP

Critical Care August 2004 Vol 8 No 4 Boyle et al. Review Equipment review: The molecular adsorbents recirculating system (MARS?) Martin Boyle1, Jelica Kurtovic2, David Bihari3, Stephen Riordan4 and Christian Steiner5 1Clinical Nurse Consultant – Intensive Care, Department of Intensive Care, The Prince of Wales Hospital, Randwick, NSW, Australia 2Fellow in Hepatology, Gastrointestinal and Liver Unit, The Prince of Wales Hospital, Randwick, NSW, Australia 3Associate Professor, Senior Staff Specialist, Department of Intensive Care, The Prince of Wales Hospital, Randwick, NSW, Australia 4Associate Professor of Medicine and Director, Gastrointestinal and Liver Unit, The Prince of Wales Hospital, Randwick, NSW, Australia 5Marketing Director, Teraklin AG, Hamburg, Germany, and Visiting Research Fellow, Institute of Hepatology, UCL, London, UK Corresponding author: Stephen Riordan, riordans@.au Published online: 24 June 2004 Critical Care 2004, 8:280-286 (DOI 10.1186/cc2895) This article is online at /content/8/4/280 ? 2004 BioMed Central Ltd Abstract The molecular adsorbents recirculating system (MARS?) is a form of artificial liver support that has the potential to remove substantial quantities of albumin-bound toxins that have been postulated to contribute to the pathogenesis of liver cell damage, haemodynamic instability and multi-organ failure in patients with acute liver failure (ALF) and acute-on-chronic liver failure (AoCLF). These toxins include fatty acids, bile acids, tryptophan, bilirubin, aromatic amino acids and nitric oxide. Data from controlled clinical trials are limited so far. One of two studies performed on small numbers of patients with AoCLF suggest a survival benefit, but no controlled data are available in the ALF setting. Our preliminary experience with MARS therapy, instituted late in the clinical course of five patients with severely impaired liver function, including three with AoCLF precipitate