Perioperative management of lung transplantation has recently evolved with an increasing use of intraoperative extracorporeal circulation (ECC) reported in the literature.1 Intraoperative ECC for management of lung transplantation can be achieved with an extracorporeal membrane oxygenation (ECMO) circuit, cardiopulmonary bypass (CPB) circuit, or a hybrid ECMO-CPB circuit.2 We previously described a novel design for an intraoperative hybrid ECMO circuit that is both cost-effective and facilitates conversion to CPB if necessary (Figure 1).2 Our novel technique for intraoperative management of the hybrid ECMO-CPB circuit, including considerations for monitoring and an organ-based management approach including cardiac, respiratory, and neurological systems is described.
Technique