Anesthesia practices for lung transplantation in China: a nationwide survey

BACKGROUND: Limited information is available regarding the current state of anesthetic practices in lung transplantation (LTx) anesthesia across China. A nationwide questionnaire survey was conducted to investigate the issue in LTx anesthesia practice. METHODS: A descriptive, cross-sectional study was performed using a multi-center online questionnaire. The survey covered various aspects, including respondent training experiences in LTx anesthesia, utilization of advanced devices/techniques during LTx anesthesia, perceived clinical views, and challenges of LTx anesthesia. RESULTS: A total of 168 valid responses were collected from anesthesiologists involved in LTx anesthesia across 44 hospitals in China, with a questionnaire completion proportion of 78.87%. Among the respondents, 60.12% (n=101) received formal LTx anesthesia training, while 63.69% (n=107) had participated in fewer than 10 LTx cases; 90.09% (n=91) of those who received training completed programs lasting less than six months. Cross-disciplinary expertise in other transplant anesthesia was reported by 92.86% (n=156) of respondents. Advanced devices/techniques were widely utilized, including extracorporeal membrane oxygenation (ECMO, 97.62%, n = 164), Swan-Ganz catheters (95.24%, n = 160), and transesophageal echocardiography (TEE, 87.50%, n = 147); however, some anesthesiologists still lacked hands-on experience. LTx anesthesia was identified as the most challenging transplant scenario by 68.45% (n=115) of respondents, and over 92% (n=155) supported the establishment of a national LTx anesthesia database. CONCLUSIONS: Advanced technologies in LTx anesthesia have been widely adopted in China, yet persistent skill gaps, fragmented training, and institutional disparities remain. Structured, simulation-enhanced training pathways and centralized outcome tracking are strongly recommended to address LTx-specific competency challenges. Establishing a national LTx anesthesia database is broadly supported to standardize practices, and urgent implementation of regional simulation hubs and competency certification is pivotal for improving perioperative outcomes of LTx.