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

Published 2 June 2025

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

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 39 recommendations regarding intraoperative considerations for ECLS in lung transplantation met consensus criteria. 

This postoperative consensus focuses on criteria for postoperative implementation, organ-system based MDT management, and considerations for future research and technological development for ECLS in lung transplantation.

Read at JHLT