Multidisciplinary Approach for Lung Transplantation due to COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation.

Keywords: ARDS, acute respiratory distress syndrome; CAD, coronary artery disease; COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; ESLD, end-stage lung disease; ICU, intensive care unit; MCF, Mayo clinic in Florida; MDT, multidisciplinary team; OR, operating room; PCR, polymerase chain reaction; POD, postoperative day; PPE, personal protective equipment; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VA, veno-arterial; VV, veno-venous.

Figure 1

Mayo criteria for extracorporeal membrane oxygenation initiation in coronavirus disease 2019. ARDS, acute respiratory distress syndrome; COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; EF, ejection fraction; FiO₂, fraction of inspired oxygen; NMB, neuromuscular blocker; PaCO₂, partial pressure of carbon dioxide within the blood; PBW, patient body weight; PEEP, positive end expiratory pressure; PF, PaO2/FiO2 ratio; R/O, rule out; RESP, respiratory; SaO₂, oxygen saturation; SBP, systolic blood pressure; TV, tidal volume; Tx, transplantation; VV, veno-venous. ©2022 Mayo Foundation for Medical Education and Research. Materials and information are current as of February 24, 2022.

Figure 2

Mayo clinic in Florida transfer coronavirus disease 2019–related lung disease criteria. BMI, body mass index; CAD, coronary artery disease; CCM, critical care medicine; COVID, coronavirus disease; CT, computed tomography; CTS, cardiothoracic surgery; ECMO, extracorporeal membrane oxygenation; MCF, Mayo clinic in Florida; VTE, venous thromboembolism. ©2022 Mayo Foundation for Medical Education and Research. Materials and information are current as of February 24, 2022.

Figure 3

Mayo clinic in Florida cardiogenic shock communication pathway. CCS, critical care service; CS, cardiogenic shock; CT, computed tomography; CV, cardiovascular; CVT, cardiovascular and thoracic; ECMO, extracorporeal membrane oxygenation; eCPR, extracorporeal cardiopulmonary resuscitation; FLA, Florida; HR, heart rate; MAP, mean arterial pressure; MCS, mechanical circulatory support; MICU, medical intensive care unit; NEE, norepinephrine; PCI, percutaneous coronary intervention; PE, pulmonary embolism; RN, registered nurse; SBP, systolic blood pressure; STAR, stat team and response; VA, veno-arterial; VF, ventricular fibrillation; VIS, vasopressin; VT, ventricular tachycardia. ©2022 Mayo Foundation for Medical Education and Research. Materials and information are current as of February 24, 2022.