Bloody Lung Transplants

[KLPM]

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As a student seeking advice of the wise ones.

Our ICU has admitted 4 cases of lung transplants over the past two weeks for either end-stage COPD or cystic fibrosis. 3 of these cases all had massive intra-operative bleeds necessitating use of many units of blood products (I think one of them got 12 units in the form of pRBCs and FFPs). One of them even went into cardiac arrest. I've had no experiences with transplants before this year.

Is this a common occurrence? Where is the bleed from (in case there is actually a part of the procedure that bleeds loads)? Any prophylactic measures?

 

[psychbender]

While my number of lung transplants is low, that degree of blood loss seems abnormal. As for where the blood is coming from, remember that giant artery that goes from the right heart to the lungs? Turns out, a lot of blood good through there.

 

[jwk]

While my number of lung transplants is low, that degree of blood loss seems abnormal. As for where the blood is coming from, remember that giant artery that goes from the right heart to the lungs? Turns out, a lot of blood good through there.

Ah yes - close corollary - if that lymph node you see during mediastinoscopy pulsates, please don't biopsy it.

 

[urge]

Do they do them on bypass?

 

[KLPM]

Do they do them on bypass?

The bleeders all ended up on bypass for various reasons: cardiac arrest, impossible to ventilate etc.

Whether that's planned or not I am unsure.

 

[Idiopathic]

so much better for these guys if they dont go on pump. plenty of reasons to expect bleeding, like severe long standing fibrosis, chest wall inflammation, lots of steroids, and then the fact that you are intentionally making holes in large vessels. notoriously coagulopathic as well

 

[Idiopathic]

i say this to all the residents and ill say it here: the off pump double lung transplant is the single most difficult anesthetic there is. we do about 10-15 a year, most of them do well, but our surgeons are excellent and i think their surgical success rate is pretty good

 

[psychbender]

i say this to all the residents and ill say it here: the off pump double lung transplant is the single most difficult anesthetic there is. we do about 10-15 a year, most of them do well, but our surgeons are excellent and i think their surgical success rate is pretty good

Where are you now, and is there an Anes-CCM fellowship there?

 

[WholeLottaGame7]

Our institution does ~150/yr, singles and doubles, the vast majority of which are off-pump. Agree that it is the most difficult case type I've done, much worse than the livers I've been a part of (though I've heard of some epic liver transplants, also). I liken it to a rodeo: you just have to hold on for dear life and hope you come out the other side. And bring lots of double-dilute epi...

 

[G0S2]

i say this to all the residents and ill say it here: the off pump double lung transplant is the single most difficult anesthetic there is. we do about 10-15 a year, most of them do well, but our surgeons are excellent and i think their surgical success rate is pretty good

Agree. Most difficult cases as resident and luckily don't do them in PP. Like any large thoracic cases; they bleed like stink.

 

[urge]

i say this to all the residents and ill say it here: the off pump double lung transplant is the single most difficult anesthetic there is.

Agree.