EVLP Priming and Preparation for Lung Transplant

A–Z of EVLPD Usage for Lung Recovery: Assessment begins with careful donor lung selection and baseline evaluation; Bronchoscopy is performed to clear secretions and inspect airways; Cannulation of the pulmonary artery and left atrium enables circuit connection; Deoxygenated perfusate mimics physiologic venous blood to assess gas exchange; Evaluation of compliance, pulmonary vascular resistance, and oxygenation guides suitability; Flow is gradually increased to target cardiac output; Gas ventilation with protective settings prevents barotrauma; Hemodynamic stability is maintained through controlled pressures; Imaging and serial bronchoscopy monitor edema and airway integrity; Judicious recruitment maneuvers improve atelectasis; Kinetics of lactate and inflammatory markers are trended; Lung reconditioning occurs via normothermic perfusion; Monitoring includes real-time blood gases and mechanics; Normothermia optimizes cellular metabolism; Oxygenation gradients (ΔPO₂) confirm function; Perfusion is adjusted to limit shear stress; Quality improvement targets marginal lungs; Rehabilitation with antibiotics, steroids, or fibrinolytics treats injury; Sterility is strictly preserved; Time on circuit is optimized to avoid injury; Ultrastructure preservation minimizes ischemia-reperfusion damage; Ventilation strategies remain lung-protective; Weaning assesses stability off support; X-factor decision-making integrates multidisciplinary judgment; Yield increases transplantable lungs; and Zero-injury principles aim for safe implantation and improved post-transplant outcomes.