Routine vs On-demand ECMO for Lung Transplantation

Routine intraoperative venoarterial ECMO during lung transplant

"Selective, indication-based intraoperative cardiopulmonary support. In this group, the transplant will be planned without cardiopulmonary support. intraoperative venoarterial ECMO will be used selectively based on hemodynamic and/or gas exchange abnormalities :~1. Inability to maintain adequate hemodynamics and stable perfusion despite volume resuscitation and vasopressor administration and in the absence of readily correctable cause~2. Inability to tolerate pulmonary artery clamping~3. Inadequate gas exchange despite attempts at the optimization of ventilator parameters and treatments related to respiratory mechanics and ventilation/perfusion matching~4. Inadequate exposure to the surgical field~5. The transplant team is concerned about the ability to maintain organ perfusion or ventilate with a lung protective strategy, even if the aforementioned criteria are unmet.~6. Concerns about donor lung quality and a desire to protect the implanted lung from single lung perfusion"