The Impact of Anesthetic Management on Perioperative Outcomes in Lung Transplantation

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

“…Specific recipient, donor, and surgical characteristics are associated with increased post-transplantation mortality in cardiothoracic transplantation, and should be recognized to optimize organ allocation and clinical outcomes. 70 , 72 Recipient end-organ dysfunction, including cardiac, hepatic, renal, or pulmonary failure, has the highest overall correlation with post-transplantation mortality at 90 days. At 1-year, mortality is impacted by need for mechanical ventilation, advanced donor age, or donor ischemic time greater than 4 hours.…”

Intraoperative management of a hybrid extracorporeal membrane oxygenation circuit for lung transplantation

“…5 Maintaining a balance between the ECMO flows and native cardiac output is a necessity to achieve appropriate systemic perfusion, avoidance of intracardiac clot formation, and provide con- achieved using a lung-protective approach with a fraction of inspired oxygen (FiO 2 ) <40%. 1,8 We also administer inhaled anesthetic via both the hybrid ECMO circuit and the anesthesia machine, as the use of inhaled anesthetics has been shown to decrease the formation of pulmonary edema and improve partial pressure of oxygen/FiO 2 ratios in animal lung transplantation models. 1…”

Intraoperative Management of a Hybrid Extracorporeal Membrane Oxygenation Circuit for Lung Transplantation

“…Mechanical ventilation of the lungs on ECMO is based on evidence from the literature, with the goal of minimizing injury to the implanted grafts being achieved using a lung protective approach with fraction of inspired oxygen (FiO 2 ) < 40%. 1,8 We also administer inhaled anesthetic via both the hybrid ECMO circuit and the anesthesia machine, as the use of inhaled anesthetics has been shown to decrease formation of pulmonary edema and improve partial pressure of oxygen/FiO 2 ratios in animal lung transplantation models. 1…”

“…Perioperative management of lung transplantation has recently evolved with an increasing use of intraoperative extracorporeal circulation (ECC) reported in the literature. 1 Intraoperative ECC for management of lung transplantation can be achieved with an extracorporeal membrane oxygenation (ECMO) circuit, cardiopulmonary bypass (CPB) circuit, or a hybrid ECMO-CPB circuit. 2 We previously described a novel design for an intraoperative hybrid ECMO circuit that is both cost-effective and facilitates conversion to CPB if necessary ( Figure 1).…”