Practical considerations for developing a lung transplantation anesthesiology program

Fritz, Ashley Virginia; Martin, Archer Kilbourne; Ramakrishna, Harish

doi:10.1007/s12055-021-01217-x

Cited by 3 publications

(5 citation statements)

References 47 publications

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Section: Discussionmentioning

confidence: 99%

“…After the ECMO is weaned, TEE evaluation to assess the patency and peak velocities of pulmonary vasculature anastomoses should be performed utilizing color flow, continuous wave, and pulsed wave Dopplers. 29 Postoperative continuation of ECMO is utilized in the setting of PGD or if the ESLD is primary pulmonary hypertension. 19 In the setting of PGD, early initiation of VV ECMO is linked to improved survival outcomes, whereas prolongation of VA ECMO in patients with primary pulmonary hypertension allows for gradual biventricular remodeling.…”

Section: Intraoperative Ecmo and Ventilation Managementmentioning

confidence: 99%

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Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Liang

Fritz

Martin

2022

Semin Cardiothorac Vasc Anesth

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Lung transplantation (LTx) historically was performed with cardiopulmonary bypass (CPB) or Off-pump. Recent data suggest an increased interest in extracorporeal membrane oxygenation (ECMO) as perioperative circulatory support by many lung transplantation centers worldwide. However, there are no established guidelines for anesthetic management for LTx. We present a patient with a history of systemic sclerosis and interstitial lung disease complicated by acute onset of systemic pulmonary hypertension and right heart failure undergoing LTx. We aim to discuss perioperative circulatory support, including ECMO bridge to LTx, and how best to consider the varied intraoperative strategies of CPB vs ECMO vs off-pump during LTx, intraoperative maintenance, and coagulation management.

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Section: Discussionmentioning

confidence: 99%

Section: Intraoperative Ecmo and Ventilation Managementmentioning

confidence: 99%

Perioperative Circulatory Support and Management for Lung Transplantation: A Case-Based Review

Liang

Fritz

Martin

2022

Semin Cardiothorac Vasc Anesth

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“…If cannulation is necessary, TEE is vital in guiding aortic and venous cannulation ( 87 ). Intracardiac shunts should be identified as shifts in right atrial (RA) and left atrial (LA) pressure can cause shunt reversal and hypoxia ( 80 , 84 , 88 ). Of note, Subramaniam found that 12.7% respondents in their survey always closed a patent foramen ovale (PFO), while 24.9% did not and the majority intervened on a case-by-case basis ( 89 ).…”

Section: Perioperative Echocardiographymentioning

confidence: 99%

“…The role of a perioperative TEE service is vital in the care of LTx recipients. TEE is a quick and feasible bedside exam that provides immediate diagnostic information allowing for guided therapeutic intervention ( 88 ). Although anesthesiologists are already using TEE for most LTxs, further evidence is needed from large, multicenter studies to better establish quantifiable echocardiographic parameters for normal and abnormal findings.…”

Section: Perioperative Echocardiographymentioning

confidence: 99%

Update in lung transplantation: anesthetic considerations

Fritz,

Teixeira,

Patel

et al. 2023

Ann Transl Med

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The field of lung transplantation (LTx) has expanded rapidly since its inception in the early 1960s with the work of James Hardy and colleagues at the University of Mississippi from the work of local single specialty physicians into an international multidisciplinary specialty. Advancements throughout the next several decades have led to the completion of over 70,000 lung transplants worldwide. The unique challenges presented by patients with end-stage lung disease have both evolved and remained consistent since then, yet these challenges are being answered with major improvements and advancements in perioperative care in the 21st century. The current practice of LTx medicine is fundamentally multidisciplinary, and members of the LTx team includes surgeons, physicians, and allied health staff. The integration of anesthesiologists into the LTx team as well as the multidisciplinary nature of LTx necessitates anesthetic considerations to be closely incorporated into emerging surgical, medical, and systems techniques for patient care. This review discusses a host of emerging strategies across the spectrum of LTx, including efforts to expand the donor pool, utilization of perioperative extracorporeal life support, perioperative echocardiography, and anesthetic techniques to mitigate primary graft dysfunction that have all contributed to improved long term outcomes in LTx patients.

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“…1,2 A key intersection of multidisciplinary teams (MDTs) and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes in patients with ESLD. 3,4 The first major case series describing early outcomes in lung transplantation focused on the surgical considerations for COVID-19 as well as preliminary proposed criteria for pursuing transplantation in patients with COVID-19erelated ESLD. 5 Since then, several other high-volume centers have published their institutional experience in lung transplantation for COVID-19.…”

mentioning

confidence: 99%