The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation.

OBJECTIVE: The 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. METHODS: The 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. RESULTS: The 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. CONCLUSIONS: Achieving 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.

Specific Considerations for Venovenous Extracorporeal Membrane Oxygenation During Coronavirus Disease 2019 Pandemic.

Extracorporeal membrane oxygenation (ECMO) is recognized as organ support for potentially reversible acute respiratory distress syndrome (ARDS). However, limited resource during the outbreak and the coagulopathy associated with coronavirus disease 2019 (COVID-19) make the utilization of venovenous (VV) ECMO highly challenging. We herein report specific considerations for cannulation configurations and ECMO management during the pandemic. High blood flow and anticoagulation at higher levels than usual practice for VV ECMO may be required because of thrombotic hematologic profile of COVID-19. Among our first 24 cases (48.8 ± 8.9 years), 17 patients were weaned from ECMO after a mean duration of 19.0 ± 10.1 days and 16 of them have been discharged from ICU.

CT Chest at discharge in Hospitalized Covid-19 patients: Should we worry about the long term evolution of parenchymal lesions? (preprint)

Objectives: Covid-19 epidemic has led to thousands of hospitalized patients and the fear of long-term pulmonary sequelae is real. This preliminary study aimed at describing the pattern of lung parenchymal lesions in patients at the time of clinical recovery. Methods Patients who were hospitalized for a severe Covid-19 pneumonia and who underwent a CTchest less at the time of discharge were included. CT scan parenchymal lesions were classified using international recommendations and compared to the diagnostic CT scan. Results We included 32 patients, median age 57 yo [26-89]. Out of them, 10 patients required ICU admission. The median hospital stay was 12 days [4-28]. All CT chest at discharge showed persistent parenchymal abnormalities regardless of the time of clinical recovery or ICU requirement. The main radiological pattern at admission was bilateral ground glass opacities in 28/30 (93.3%), associated in 12 patients (40%) with areas of consolidation, and organized pneumonia in 8 patients (27%). At discharge, the main radiological pattern remained bilateral ground glass opacities in 29/32 patients (91%) associated with consolidation in 3/32 patients (9%) and organized pneumonia in 25/32 patients (78%). There was no correlation between lesions extent and clinical severity, particularly ICU requirement. Conclusion CT-chest of patients recovering from severe covid-19 show parenchymal persistent abnormalities: careful consideration of the organisation of recovery of lung function follow-up is thus needed and the question of antifibrotic agent usefulness may be anticipated.Conclusion CT-chest of patients recovering from severe covid-19 show parenchymal persistent abnormalities : careful consideration of the organisation of recovery of lung function follow-up is thus needed and the question of antifibrotic agent usefulness may be anticipated.