Transatlantic Educational Network: An Innovation Born of Necessity

The coronavirus disease 2019 pandemic brought about many changes in the delivery of healthcare, graduate medical education, and collaborative efforts across academic medicine. While there was a temporary disruption in the fluid delivery of services, longer-term benefits emerged with the leveraging of innovative technology and multicenter collaborations. These new opportunities led 14 centers in the United States and Europe to develop a novel, remote, and collaborative educational effort in cardiovascular and thoracic anesthesiology, known as the Transatlantic Educational Network. This paper describes the initial pilot structure and preimplementation data and provides a rationale for the development and expansion of the pilot program in other areas of anesthesiology.

Perioperative fluid management for lung transplantation is challenging

Lung transplantation is the definitive end-stage treatment for many lung diseases, and postoperative pulmonary oedema severely affects survival after lung transplantation. Optimizing perioperative fluid management can reduce the incidence of postoperative pulmonary oedema and improve the prognosis of lung transplant patients by removing the influence of patient, donor's lung and ECMO factors. Therefore, this article reviews seven aspects of lung transplant patients' pathophysiological characteristics, physiological characteristics of fluids, the influence of the donor lung on pulmonary oedema as well as current fluid rehydration concepts, advantages or disadvantages of intraoperative monitoring tools or types of fluids on postoperative pulmonary oedema, while showing the existing challenges in section 7. The aim is to show the specificity of perioperative fluid management in lung transplant patients and to provide new ideas for individualised fluid management in lung transplantation.

Current status and training needs of trainee anesthesiologists in lung transplantation anesthesia in China: A single-center survey

Background

Perioperative management involving anesthesiologists plays an important role in prognosis of recipients after lung transplantation. Since the development of lung transplantation, the demand for specialized anesthesiologists continues to increase. As the largest lung transplant center in China, the Wuxi People's Hospital was tasked with trainee anesthesiologists throughout the country in lung transplantation anesthesia. This study aimed to evaluate the current status and training needs of anesthesiologists for the anesthetic management of lung transplantation in Wuxi People's Hospital between 2015 to 2020.

Methods

Overall, 53 trainee anesthesiologists for lung transplantation from 35 hospitals were investigated anonymously in our survey. The questionnaire included the anesthesiologists' demographic information, level of satisfaction, training needs and current status in their hospitals. We divided the doctors into two groups depending on the trainee anesthesiologists' seniority and professional title: intermediate and senior. Survey data were compared between the groups.

Results

Significantly more doctors in senior-level positions had clinical research experience than did doctors in intermediate-level positions (P = 0.041). All doctors were highly or very highly satisfied with the training received. Doctors in intermediate-level positions preferred training periods of 4-6 months, while those in senior-level positions preferred 1-3 months of training (P = 0.044). Most doctors considered theoretical courses to be lacking (69.0%), followed by a lack of scenario simulation teaching (54.8%). The most desirable programs were transesophageal echocardiography (TEE, 71.4%) and extracorporeal membrane oxygenation (ECMO, 64.3%). ECMO technology was available in the hospitals of 95.2% of respondents; however, only 2.4% of doctors said the anesthesiology department took charge of perioperative ECMO. Significantly more senior-level doctors chose calibrated pulse contour analysis (P = 0.018) and significantly more intermediate-level ones chose TEE (P = 0.049). Disappointingly, 21.4% doctors reported a lack of certification evaluation for trainee anesthesiologists at their hospitals.

Conclusions

Different training programs should be set up according to the trainee anesthesiologists' level of seniority and training needs. Theoretical courses and scenario simulation training must be added to improve the training program. Moreover, the training of TEE and ECMO requires greater attention. Finally, a standardized completion assessment is required for trainee anesthesiologists.

Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship

The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of "Abdominal Organ Transplant Anesthesia" recommended knowledge.

Practical considerations for developing a lung transplantation anesthesiology program

The advancement in lung transplantation outcomes has been secondary to ongoing improvements within multiple medical specialties. The recent emergence of literature describing the impact of anesthetic management on perioperative outcomes has led to the beginnings of formalized training fellowships within lung transplantation anesthesiology. Practical considerations for the development of a lung transplantation anesthesiology program, both clinical and educational, are herein described.

The Year in Cardiothoracic Transplantation Anesthesia: Selected Highlights from 2019

The highlights in cardiothoracic transplantation focus on the recent research pertaining to heart and lung transplantation, including expansion of the donor pool, the optimization of donors and recipients, the use of mechanical support, the perioperative and long-term outcomes in these patient populations, and the use of transthoracic echocardiography to diagnose rejection.