The first COVID-19 double lung transplant in the U.S. made national headlines in the summer of 2020.

The recipient was a young woman in her 20s whose lungs were ravaged by the novel coronavirus. While this surgery made national news, lung transplants in the U.S. have been steadily increasing since 2012. This is thanks to an increase in donors and improved treatments for end-stage lung diseases, according to the Cleveland Clinic.

The number of lung transplants in the U.S. increased 7.3 percent from 2018 to 2019, according to the United Network of Organ Sharing (UNOS). UNOS reported 2,714 lung transplants in the U.S. in 2019. About two-thirds of lung transplants are due to pulmonary fibrosis.

Given the general rise in transplant surgeries, a new article in the Journal of Cardiothoracic and Vascular Anesthesia argues anesthesiologists need to be familiar with the various tools available for one-lung ventilation (OLV) – a requirement for lung transplants. “Airway Management During Anesthesia for Lung Transplantation: Double-Lumen Tube or Endobronchial Blocker?” breaks down several OLV techniques and tools and best-case scenarios for each. The article published in September 2020.

While a left-sided double-lumen tube is preferred for OLV, according to the authors, anesthesiologists should consider the type of transplant (single or double), location of airway anastomosis, and whether mechanical circulatory support is being used in surgery when selecting tools.

Double-Lumen Tube

Benefits

• Easily switch from one-lung to two-lung ventilation if necessary, without moving the tube.
• Offers superior seal compared with other ventilation options.
• Enables continuous positive airway pressure to treat low blood oxygen levels.
• Allows for suction of blood and mucus during procedure.
• Ambu VivaSight DLT is left-sided and camera technology provides the ability to place the tube without a bronchoscope and continuous visualization for anesthesiologist.

Challenges

• May be difficult to place depending on size of the patient or patients with abnormal tracheobronchial anatomy.
• Large structure can harm upper airways, leading to patient sore throat, tracheal and bronchial hematoma, or vocal cord injuries.
• If a switch to single-lumen tube is required due to length of surgery, there is a risk of losing the secured airway and presenting possible infection.

Bronchial Blockers

Benefits

• Easier to place in difficult airway anatomies.
• Offers less risk of laryngeal and tracheal trauma or damage.
• Enables continuous positive airway pressure to treat low blood oxygen levels.

Challenges

• Placement requires use of a bronchoscope and may take longer than a double-lumen tube.
• May require frequent adjustments during surgery as patient is repositioned.

“The diversity of OLV methods offers providers flexibility and has led many anesthesiologists to develop a preferred technique,” the authors conclude. “Although it remains contested which OLV technique is most effective and has fewer adverse effects, anesthesiologists should be familiar with the various products and appreciate when one device may be favored over another in the setting of lung transplantation.”