Nothing new today — closing the ISHLT gap with the three-part perioperative ECLS consensus, plus ERC 2025 on special circumstances and ethics

No new guidelines from tracked societies today. All three sweeps ran clean with no query failures across the trailing window 12–14 September: the topic-wide guideline search (20 hits, none in scope with readable content), the society-acronym sweep — a confirmed zero, and the French sweep, which returned two Infectious Diseases Now items (pneumococcal carriage in Moroccan toddlers; low-dose amoxicillin prophylaxis for recurrent erysipelas), both original research rather than guideline output. SFAR, SPILF and SRLF have now published no guidelines for fourteen days.

Two in-scope documents surfaced and both are unreadable: the Brazilian Thoracic Society guidelines for the pharmacological treatment of pulmonary hypertension (13 September, two companion papers) and Chinese clinical practice guidelines on liver transplantation for extended criteria donor grafts, 2025 edition (14 September, DOI 10.1097/cm9.0000000000004232). Neither has an abstract deposited in Europe PMC and neither full text was reachable. Both go to the outstanding list rather than being described from their titles.

So the day went to the backlog — and specifically to the second gap the scope audit on Saturday turned up.

Closing the ISHLT gap

That audit found ERC and ILCOR had never been on the society list despite resuscitation being named in primary scope. It flagged a second omission at the same time: ISHLT — the International Society for Heart and Lung Transplantation — returned zero documents across the whole archive. Today’s first ISHLT sweep returned 134 consensus statements and guidelines.

The obvious place to start is the document that sits exactly where this project’s scope converges — cardiothoracic surgery, anaesthesia, and intensive care, on extracorporeal support.

1–3. ISHLT perioperative ECLS in lung transplantation — the three-part consensus

Society · Published: International Society for Heart and Lung Transplantation, Standards and Guidelines Committee. The Journal of Heart and Lung Transplantation, in three parts: Part II (intraoperative) 23 October 2024 — ~23 months old; Part III (postoperative) 2 June 2025 — ~15 months old; Part I (preoperative) 17 October 2025 — ~11 months old Martin, Mercier, Reed, Fritz, Gelzinis, Hoetzenecker, Lindstedt, Marczin, Wilkey, Fessler, Bottiger, Cypel, Dellgren, Kukreja, Levvey, Lyster, Sanchez, Schecter, Saatee, Kotecha, Behr, Wille, Nasir, Gomez-De-Antonio, and others across all three parts

Note the publication order: the intraoperative part came first, the preoperative part last. All three share an identical methods paragraph, which is worth quoting because it describes the document’s whole character:

The use of extracorporeal life support throughout the perioperative phase of lung transplantation requires nuanced planning and execution by an integrated team of multidisciplinary experts. To date, no multidisciplinary consensus document has examined the perioperative considerations of how to best manage these patients.

The panel composition is the striking part:

International experts across multiple disciplines, including cardiothoracic surgery, anesthesiology, critical care, pediatric pulmonology, adult pulmonology, pharmacy, psychology, physical therapy, nursing, and perfusion, were selected based on expertise and divided into subgroups examining the preoperative, intraoperative, and postoperative periods.

Method: comprehensive literature review, then structured Delphi, two rounds per subgroup.

The output, by phase:

• Part I — preoperative: 50 recommendations, on criteria for preoperative ECLS and multidisciplinary team management through the preoperative phase
• Part II — intraoperative: 39 recommendations, on planning, implementation, management and monitoring of ECLS throughout the intraoperative period
• Part III — postoperative: 22 recommendations, on criteria for postoperative ECLS and team management across the postoperative spectrum

111 recommendations in total.

Interpretation. Three observations, and the first is about who wrote it rather than what it says.

This is the document this project’s scope was built to find. Anaesthesiology, cardiothoracic surgery, intensive care and perfusion at one table, producing recommendations on extracorporeal support through an entire operation. It has been in print for almost two years in its earliest part, and until today this archive had never mentioned the society that produced it. That is the cost of building a landmark backlog around a society list rather than around the stated scope, and it is the second time in three days that the audit has paid out.

The distribution of recommendations is itself informative: 50 preoperative, 39 intraoperative, 22 postoperative. More than twice as much consensus content on the decision to start as on what to do afterwards. That is the familiar shape of a field where selection is contested and management is improvised — and it matches the ECLS literature, where the arguments are about candidacy and timing while post-cannulation care runs on local protocol. Part III having the fewest recommendations is not a sign the postoperative period is simple.

Delphi consensus, not graded evidence. None of the three abstracts mentions GRADE, evidence certainty, or strength of recommendation — only that items “met consensus criteria” after two rounds. That is the right method for a question no trial has addressed, and it means these are expert agreements about practice, not evidence statements. The same caution applies as to the DESTINE 2.0 driveline recommendations and the prehospital paediatric transfusion Delphi covered this month.

Where this connects. ECLS and renal injury have been a running thread: the ADQI XXXVI / ELSO consensus three days ago named non-pulsatile flow, venous congestion and haemolysis as drivers of AKI on ECMO, and today’s brief carried a 1,358-patient cohort in which 71% of VA-ECMO survivors who received CRRT left hospital dialysis-dependent. Lung transplant ECLS is predominantly venovenous or central VA for the operation itself, so the configurations differ — but the perioperative team making the cannulation decision in Part I is making a renal decision too, and neither document cross-references the other.

Access note: all three abstracts were read in full and are quoted above. The 111 recommendations themselves are not in the abstracts — each abstract describes scope, method and count only, the same pattern seen with the AHA statements and the ERC sections. The full texts were not reachable. What is reported here is the architecture of the document, not its content.

There is also a companion written specifically for anaesthetists, which is the most useful entry point if you have journal access: “The ISHLT Consensus Statement on the Perioperative Use of ECLS in Lung Transplantation: Highlights and Perioperative Implications” — Wanar and Weiner, Journal of Cardiothoracic and Vascular Anesthesia, 18 February 2026, DOI 10.1053/j.jvca.2026.02.026, PMID 41826200. Its stated aim: “This review will highlight and summarize the key points most relevant to the cardiac anesthesiologist when caring for these patients.” Its abstract carries no content either.

Part I — preoperative · PMID 41105058 · Part II — intraoperative · PMID 39453286 · Part III — postoperative · PMID 40455186

4. ERC Guidelines 2025 — Special Circumstances in Resuscitation

Society · Published: European Resuscitation Council. Resuscitation, October 2025 — eleven months old Lott, Karageorgos, Abelairas-Gomez, Alfonzo, Bierens, Cantellow, Debaty, Einav, Fischer, González-Salvado, Greif, Metelmann B, Metelmann C, Meyer, Paal, Peran, Scapigliati, Spartinou, Thies, Truhlar, Deakin

The highest-priority remaining ERC 2025 section for this scope, and the next one off the list after Saturday’s backfill of the executive summary, adult ALS and post-resuscitation care.

Per the abstract: based on the 2025 ILCOR CoSTR, expert writing group reviews and peer-reviewed literature, the chapter provides guidance for laypeople and healthcare professionals on:

the modifications required to basic and advanced life support in adults for the prevention and treatment of cardiac arrest, for in-hospital and out-of-hospital cardiac arrest.

Special circumstances in children are covered in the Paediatric Life Support section instead.

Interpretation. As with every ERC 2025 section, the abstract states scope and nothing else — no list of which special circumstances, no recommendations. That is a real limitation and it is why this is reported as a pointer rather than a summary.

What can be said from the author list, which is unusually informative here: Paal (mountain and avalanche medicine), Truhlar (special circumstances lead in previous editions), Bierens (drowning), Alfonzo (dialysis and electrolyte disorders), Einav (obstetric and perioperative arrest) and Debaty (hypothermia, ECPR). That composition tells you the chapter covers hypothermia and avalanche burial, drowning, electrolyte disorders and renal failure, obstetric arrest, trauma, and perioperative arrest — the traditional scope of this section — though I am reading the authorship, not the document.

For this archive’s readers the perioperative arrest content is the reason to obtain it. Cardiac arrest in theatre or in the ICU has a different differential, a different response time and usually a different reversible cause from a collapse in the street; a resuscitation guideline’s special-circumstances chapter is where that is addressed, and it is not addressed anywhere in the adult ALS chapter.

Read the section · PMID 41117569

5. ERC Guidelines 2025 — Ethics in Resuscitation

Society · Published: European Resuscitation Council. Resuscitation, October 2025 Raffay, Wittig, Bossaert, Djakow, Djärv, Estella, Lulic, Mentzelopoulos, Monsieurs, Van de Voorde, Lauridsen, and the ERC Ethics in Resuscitation Collaborators

The one ERC section whose abstract has real content, and it lands in the middle of a thread this archive has been working for four days.

Topics covered, per the abstract: advance care planning; the involvement of bystanders and first responders; family presence during resuscitation; termination of resuscitation; and ethical considerations for systems, education, research, and low-resource settings. Emphasis throughout on out-of-hospital, in-hospital and paediatric arrest.

The stated aims and framings:

• “to ensure that resuscitation decisions are made in alignment with patient values and preferences“, with emphasis on a patient-centred approach
• the balance between beneficence and autonomy
• stakeholder involvement, transparency, and the use of artificial intelligence in resuscitation research
• multiple aspects of education in ethics in resuscitation

Interpretation. Read this against the last four days, because the archive has assembled an unusually complete picture of how code status actually behaves in practice, and this is the document that says how it ought to.

Three findings sit against it. The Annals of Surgery cohort on 11 September: 82% of patients with a pre-existing code-status limitation had it reversed to full code for theatre, and among those who kept it and died, 81% died after a transition to comfort-focused care — the limitation tracking prognosis rather than causing death. The RAPM fracture analgesia study on the 12th: DNR status associated with a third the odds of a rib fracture block in the least frail patients — a comfort measure withheld on the strength of a resuscitation order, in exactly the patients where frailty cannot explain it. And the prehospital paediatric transfusion Delphi yesterday, which contraindicated transfusion only for “do not resuscitate orders prohibiting transfusion” — drafted precisely against that failure mode.

“Decisions made in alignment with patient values and preferences” and “the balance between beneficence and autonomy” are the right abstractions, and the three papers above are what happens to them in a hospital. An 82% perioperative reversal rate is a question about whether advance care planning survived contact with the anaesthetic room. A DNR order reducing analgesia is a failure of exactly the beneficence–autonomy balance this chapter names.

Termination of resuscitation is the other section worth obtaining, and it connects to the WEAN SAFE phenotypes and the competing-risk benchmarking paper sent today: decisions to stop are clinical acts with measurable consequences, and they are made on prognostic information that is often weaker than the decision it supports.

The same access limit applies — the abstract lists topics and aims; the recommendations are not in it, and the full text was not reachable.

Read the section · PMID 41117566

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Also seen and out of scope: an expert consensus statement on lipoprotein(a) in Japan, AANEM carpal tunnel grading, an AISP position statement on pancreatic sample handling, two PREFERENDO paediatric endoscopy consensus documents, a German Delphi on COMT inhibitors in Parkinson’s disease, a gerodontology staging framework, a consensus on trials in rare renal cell carcinoma subtypes, the Spanish Arteriosclerosis Society document on atherogenic dyslipidaemia, and a reply in a correspondence exchange about albumin-adjusted calcium. One borderline item not pursued: an *Orbit paper evaluating novel guidelines for burn patients at risk of orbital compartment syndrome — an evaluation rather than a guideline, and ophthalmic, though burn resuscitation volumes are the underlying driver.*