Of 45 patients observed in the ICU with severe acute hepatic insufficiency, 15 patients were in hepatic coma. All patients received combined treatment consisting of standard conservative methods (drug therapy) and surgical methods for temporary support of liver function (hemodialysis, exchange blood transfusion, pig liver perfusion). Intensive therapy which began during the early phase of hepatic coma enabled us to bring six patients out of the coma, four of whom completely recovered. These studies showed that of the diseases causing hepatic coma, the worst results were obtained with viral hepatitis. This may be explained both by the extensive liver damage and marked metabolic disturbances, which led to failure of other vital organs and systems. At present, the combined therapy contributes to a greater percentage of recovery of patients with hepatic failure and coma.