BIO24: Reducing Risk of Barotrauma in Donor Lungs During Transport

Abstract

Background: The journey donor lungs take after being procured on the way to the recipient often involves the use of air transportation, subjecting the organ to different altitudes. During takeoff and at cruising altitudes, decreased atmospheric pressures lead to increased relative airway pressures, increasing the risk for barotrauma. While this may be due to underinflation during procurement, the risk of barotrauma likely still exists given the subjective nature of the process and variability between surgeons and centers. Methods: Using porcine lungs (n=3), the airway pressure of donor lungs in simulated flight takeoff and landing was actively controlled using a novel preservation system and measured with calibrated gauges. Lungs were prepared using 2L preservation solution at 4°C in the inner bag and 2L saline at 4°C in the middle bag. A modified 3 bag system allowed for the trachea to be connected to pneumatic circuit designed to maintain target airway pressures of 12-15 cmH2O per the ISHLT consensus statement. Parameters for simulated takeoff and landing (1,000ft/min), peak altitude (8,000ft), and time at peak altitude (6 hours) were chosen to reflect the worst-case scenario. Results: All airway pressures remained within 12-15 cmH2O (±1 cmH2O) following a maximum of 5-minute stabilization time after transitioning between stable ambient pressures. This demonstrates the ability of the system to maintain airway pressures within this range at pressures up to 8000ft (worst-case for pressurized aircraft cabin). During simulated takeoff and landing scenarios, all airway pressures remained within 10-20 cmH2O at 1000ft. Without active pressure control, airway pressures may increase above 30 cmH2O. Conclusions: Airway pressures during flight remained within the intended range using a novel preservation system for donor lungs. Without active control using the systems, airway pressure of lungs are subjected to unsafe levels, which may lead to suboptimal postoperative outcomes.