In a remarkable life-saving operation, surgeons were able to keep a critically ill patient alive for 48 hours without both lungs while awaiting a double lung transplant – a radical approach that could be used again in selected patients.
A team at Northwestern University has built a Total Artificial Lung (TAL) system that can oxygenate blood like our lungs while managing blood flow and protecting the heart.
The TAL is critical to stabilizing the patient and preparing him to receive a pair of donor lungs. More than two years later, the man is recovering well and his lungs are functioning normally.
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The story begins in the spring of 2023, when the 33-year-old man suffered from flu-related lung failure. The condition rapidly progresses to pneumonia, sepsis and what’s known as acute respiratory distress syndrome (ARDS).
“He had an infection in his lungs that no antibiotic could treat as it was resistant to everything,” said thoracic surgeon Ankit Bharat.
“The infection caused liquefaction in his lungs which then continued to spread to other parts of his body.”
The standard approach is to place the patient on life support and give the lungs time to recover. Here, however, the lungs were the main problem and source of infection: the man seemed certain to die if the lungs were not removed, and likely would have been if they were.
Removing both lungs (bilateral pneumonectomy) often causes heart failure due to interruption of blood flow.
To avoid this and overcome the limitations of previous attempts, the medical team behind TAL added dual blood flow channels and a flow-adaptive shunt to even out changes in blood flow.
The machine is enough to keep the patient alive long enough for his body to recover enough for a lung transplant. Once the organ is removed, signs of recovery from the infection begin to appear.
Barratt and his team conducted molecular analyzes of the lungs after they were removed, confirming that the lungs had no chance of recovering on their own from ARDS.
Scarring and immune damage mean that in this case, a lung transplant is absolutely necessary.
“Traditionally, lung transplantation has been reserved for patients with chronic diseases such as interstitial lung disease or cystic fibrosis,” Barratt said.
“Currently, people think that if you have severe acute respiratory distress syndrome and you continue to support them, eventually the lungs will get better.”
It’s a method that can be used again to save more lives: While such TAL systems can currently only be built in specialized centers, Bharat hopes that the innovative technology applied here can be incorporated into standard equipment in the future.
While a double lung transplant in this setting may have previously been thought impossible, we now know it can be done and can be successful – and may be an option in future cases, although it still depends on timely availability of a donor lung.
“In my practice, young patients die almost every week because no one realizes transplant is an option,” Barratt said.
“For severe lung injury caused by respiratory infections, even in acute settings, lung transplantation can be life-saving.”
A case report on the operation has been published in medicine.
