ISHLT consensus statement: Perioperative ECLS in lung transplantation

A review article highlighting key perioperative implications of the International Society for Heart and Lung Transplantation (ISHLT) consensus statement on the use of extracorporeal life support (ECLS) in lung transplantation was published in the Journal of Cardiothoracic and Vascular Anesthesia by Wanar and Weiner. The article summarizes preoperative, intraoperative, and postoperative recommendations from the three-part multidisciplinary consensus statement, approved by the ISHLT Standards and Guidelines Committee, with a focus on considerations for cardiac anesthesiologists. 

Key data: Preoperative ECLS management should be guided by a multidisciplinary team, focus on cannulation strategies that maximize mobility and engagement in physical therapy, and minimize sedation and mechanical ventilation. Use of low-dose or anticoagulant-free strategies while on ECLS may help limit complications in selected patients. Intraoperatively, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the preferred ECLS modality, with transesophageal echocardiography (TEE) considered an essential monitor in all recipients. Postoperatively, ECLS should be tailored to the patients’ underlying physiology, with emerging evidence that VA-ECMO may have benefit in pulmonary hypertension. ECLS may also facilitate earlier extubation and physiotherapy in appropriate patients. 

Key learning: The ISHLT consensus highlights perioperative ECLS as a multidisciplinary, individualized strategy, supporting intraoperative VA-ECMO with careful patient selection, mobility-preserving cannulation, vigilant intraoperative monitoring, early physiotherapy, and standardized postoperative weaning while further multicenter evidence is generated.