| Institution: | 1. Division of Thoracic Surgery, Duke University Medical Center, Durham, NC;2. University of Louisville School of Medicine, Louisville, Ky;3. Northwestern University, Evanston, Ill;4. Toronto General Hospital, Toronto, Ontario, Canada;5. Kyoto University Graduate School of Medicine, Kyoto, Japan;6. University Academic Center Groningen, Groningen, The Netherlands;7. Medical University of Vienna, Vienna, Austria;8. Northwell Health, New Hyde Park, NY;9. University of California San Francisco, San Francisco, Calif;10. University of Florida College of Medicine, Gainesville, Fla;11. Cleveland Clinic, Cleveland, Ohio;12. Université Paris-Saclay and Marie Lannelongue Hospital, Le Plessis-Robinson, France;13. University Hospital Zurich, Zürich, Switzerland;14. Washington University School of Medicine, St Louis, Mo;15. University Hospitals Leuven, Leuven, Belgium;1. Division of General Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex;2. Division of Medical Oncology, Mayo Clinic, Rochester, Minn;3. Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex;4. Division of Thoracic Surgery, Brigham and Women''s Hospital, Boston, Mass;1. Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania;2. Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania;3. Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;1. Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;2. General Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;3. Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;4. General Surgery Unit, Università La Sapienza, Roma, Italy |
| Abstract: | ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation. |
