Ho, ho, ho! Gather ’round, my dear friends, as I tell you a tale from the frosty frontlines of the COVID-19 pandemic. It’s a story about a medical technique called veno-venous extracorporeal membrane oxygenation (V-V ECMO), used as a bridge to transplantation or recovery. Now, this isn’t your usual Christmas tale, but it’s one that’s important nonetheless.

In the icy grip of COVID-19, the use of V-V ECMO has risen like a star on a Christmas tree. But unlike other causes of acute respiratory distress syndrome (ARDS), using V-V ECMO for COVID-19 patients often requires a longer duration of support, much like how Rudolph needed to guide my sleigh for the entire night.

Our team of elves, I mean, medical professionals, decided to evaluate the outcomes of prolonged ECMO support in these patients. They looked at patients who were on ECMO due to COVID-19 associated ARDS, specifically those who needed V-V ECMO support for more than 50 days, longer than the time it takes me to prepare all the presents!

The median age of the patients was 48 years, and 72% were males, just like the majority of my reindeer. The median duration of ECMO support was 84 days, longer than the wait for Christmas! 61% of these patients had right ventricular dysfunction and 72% had pneumothoraces, which is a bit like having a flat tire on my sleigh.

Sadly, there was a 33% mortality rate within the cohort, a reminder that not all stories have a happy ending. One patient continues to require ECMO support at the time of abstract submission, much like how some children continue to believe in me. On a brighter note, 61% of patients were discharged, with 3 requiring a lung transplant, showing that even in the darkest times, there’s always a glimmer of hope.

So, my friends, the moral of this story is that prolonged V-V ECMO can have comparable outcomes to conventional V-V ECMO runs that are shorter in duration. With the right resources and a sprinkle of Christmas magic, prolonged ECMO runs can potentially be justified in a highly selected patient population. Now, let’s all raise a glass of milk and toast to the brave medical professionals fighting this pandemic. Ho, ho, ho!

Ho ho ho! Gather ’round, my dear friends, as we delve into the magical world of orthotopic liver transplantation, a gift of life for those with end-stage liver disease. Much like the elves in my workshop, this procedure requires a team of skilled individuals, each playing their part to perfection.

Just as understanding the physics of reindeer flight is crucial for my Christmas Eve journey, comprehending the intricate pathophysiology of end-stage liver disease is essential for the anesthesiologists. They must navigate the stormy skies of fluctuating physiology, haemodynamics, metabolic, and coagulation status, much like I steer my sleigh through the winter winds.

The journey of orthotopic liver transplantation is as dynamic as the Northern Lights, with each phase – preoperative evaluation, anaesthesia induction and management, dissection, anhepatic, neo-hepatic, and postoperative care – shining with its unique hue. Each phase requires special anaesthetic considerations, just as each house I visit needs a carefully chosen gift.

The key to a successful journey, be it delivering presents or managing anaesthesia, lies in understanding the situation, adapting to changes, and avoiding missteps. A sprinkle of knowledge, a dash of the right attitude, and a hearty dose of a multimodal and multidisciplinary approach can make the difference between a bumpy ride and a smooth flight.

In our review, we’ve packed our sleigh with insights from the literature to present the perioperative and anaesthesia management in orthotopic liver transplantation patients. So, buckle up, my friends, as we embark on this fascinating journey, spreading the joy of knowledge this Christmas season. Ho ho ho!