The following is the summary of “American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation” published in the January 2023 issue of Thoracic and cardiovascular surgery by Hartwig, et al.
Over the past decade, there has been a consistent rise in the application of mechanical circulatory support (MCS) to lung transplantation, with corresponding shifts in the approach taken to integrating MCS into the preoperative, intraoperative, and postoperative phases of the procedure. However, there is a wide range of how these methods are actually implemented, and there needs to be more data to guide standardized procedures. The purpose of the expert panel assembled by the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) was to examine the current research on MCS and make recommendations for its use prior to, during, and after lung transplantation.
The AATS CPSC convened a group of 16 specialists in lung transplantation to draft a set of guidelines. The panel was divided into three groups, one for preoperative, one for intraoperative, and one for postoperative assistance, and each group conducted its own literature evaluation. Each subtopic was assigned to a group, and those groups came up with a set of recommendations that were then judged by the whole. The statements were then developed through panel discussion and refined until a consensus was reached on each statement. The panel of experts came to an agreement on 36 guidelines for the use of MCS in lung transplantation. Recommendations included central veno-arterial extracorporeal membrane oxygenation (ECMO) over conventional cardiopulmonary bypass during the transplantation procedure and the benefit of supporting selected patients with MCS postoperatively; veno-venous ECMO was recommended as a bridging strategy in the preoperative setting.
Optimal outcomes after lung transplantation necessitate the application of multiple approaches. Critically ill patients can rely on MCS as an important mechanism to help them get through the pre transplantation period. The expert panel reached a consensus on 36 recommendations despite the complexity of the decision-making process involved in treating these patients. These guidelines are intended to help doctors decide whether or not to pursue a lung transplant for patients with end-stage disease.
Source: sciencedirect.com/science/article/abs/pii/S0022522322008108
