ISHLT Consensus Statement on the Perioperative Use of ECLS in Lung Transplantation: Part I - Preoperative Considerations

Published 17 October 2025

Anna K. Reed, MD, PhD; Olaf Mercier, MD, PhD; Juergen Behr, MD, PhD, Kavita Dave, MD; Göran Dellgren, MD, PhD; Sakhee Kotecha, MD; Jasleen Kukreja, MD, PhD; Caroline Landry, CPC, MSc, Bronwyn Levvey, PhD; Haifa Lyster, PhD; Orla Morrissey, MD, PhD; Siavosh Saatee, MD; Melissa Sanchez, DClinPsy; Marc Schecter, MD; James Walsh, PhD; Ashley Fritz, DO; Theresa Gelzinis, MD; Konrad Hoetzenecker, MD, PhD; Sandra Lindstedt, MD, PhD; Nandor Marczin, MD, PhD; Barbara Wilkey, MD; Julien Fessler, MD; Brandi Bottiger, MD; Keith Wille, MD; Basil Nasir, MD; David Gomez-De-Ontonio, MD; Marcelo Cypel, MD, PhD; Archer Martin, MD

J Heart Lung Transplant. June 2025.

• Advanced Lung Failure & Transplantation
• Anesthesiology & Critical Care
• Consensus Document
• Nursing & Allied Health
• Pediatrics
• Pharmacy
• Publications & Journals
• Pulmonology
• Standards & Guidelines

The use of extracorporeal life support (ECLS) throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients. To address this challenge, this perioperative utilization of ECLS in lung transplantation consensus statement was approved for development by the International Society for Heart and Lung Transplantation Standards and Guidelines Committee. International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods. 

Following a comprehensive literature review, each subgroup developed recommendations to examine via a structured Delphi methodology. Following 2 rounds of Delphi consensus, a total of 50 recommendations regarding preoperative considerations for ECLS in lung transplantation met consensus criteria. 

This preoperative consensus focuses on recommendations for patient selection, planning for bridging initiation and supportive strategies, management during the bridging period, prevention and management of complications, and considerations for future research and technological development for ECLS as bridge to lung transplantation.

Read at JHLT