A 33-year-old man whose lungs were partially filled with pus when placed on a ventilator survived for 48 hours without his lungs, after a medical team swapped his distressed lungs with an external artificial-lung system. He has then gone on to receive a double lung transplant, and he is doing well.
An artificial lung machine, or Extracorporeal Membrane Oxygenation (ECMO), is used regularly in cases of severe heart and lung failure to deliver oxygen to the blood and remove carbon dioxide. While the technology works well, this man needed a modified ECMO that is connected to the heart and maintains proper pressure to allow blood to flow to and from the heart after his lungs were removed, since normal ECMO technology requires lungs to be inside the body to function.
In the case of this patient, using a regular ECMO wasn’t an option, as he was too unwell to receive a lung transplant. The patient’s heart and kidneys started to fail, and he had a cardiac arrest once he went into septic shock, marking the urgent need to remove his lungs, the source of infection. Initially, the man developed acute respiratory distress, a fatal condition during which the lungs cannot absorb adequate oxygen. Once he was put on a ventilator, he developed drug-resistant Pseudomonas aeroginosa infection, escalating the situation from bad to worse, and his lungs were replaced with an artificial lung-system.
“Within 48 hours, he was off all the medication to support his blood pressure, his kidney function was completely restored and his heart was working normally,” says Ankit Bharat, a thoracic surgeon at Northwestern University Feinberg School of Medicine in Chicago, Illinois. The speedy recovery allowed him to receive a double lung transplant. There have been no signs of organ rejection or impaired lung function, even after three years of the procedure.
Bharat and his team had already been working on an artificial lung-system to support people who were critically ill with COVID-19 when they were introduced to the patient. The system ensured that patients could get healthy enough to be eligible for a lung transplant. Although people who had their lungs removed are kept alive with an external device that maintains oxygen levels, Bharat regards that device as different from his. These devices do not maintain blood flow across the heart, a pivotal feature of Bharat’s machine. While a patient connected to the artificial lung-system allows normal heart function, its predecessors failed to do so.
Bharat’s design is unique because it allows continuous, balanced blood flow to the heart, reducing the risk of blood clots that can trigger heart attacks. Natasha Rogers, a transplant clinician at Westmead Hospital in Sydney, Australia, hails this feat of engineering, as maintaining normal heart function in the absence of lungs is extremely difficult. According to her, ideally, the machine can be used to support a person once their lungs are removed, treat them, and put them back. However, the whole process will require multiple experts, limiting the technology to only large hospitals.
Bharat hopes for the system to be commercialized in the future for use in any hospital. Right now, he will offer this technology to patients at Northwestern who are terminally ill, and keep tabs on the patients’ health.
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