Surgeons at Northwestern University have reported a case in which a patient survived for 48 hours without lungs, sustained by an artificial lung system until a double lung transplant could be performed. The case is detailed in the January 29 issue of the journal Med.
The patient, a 33-year-old man, developed acute respiratory distress syndrome (ARDS) after contracting the flu. His condition worsened due to bacterial pneumonia, leading to failure of his lungs, heart, and kidneys. Doctors determined that his only chance of survival was a double lung transplant.
"He was critically ill. His heart stopped as soon as he arrived. We had to perform CPR," said Ankit Bharat, lead author and thoracic surgeon at Northwestern University. "When the infection is so severe that the lungs are melting, they're irrecoverably damaged. That's when patients die."
However, because the patient's body was too weak to receive new lungs immediately, Bharat's team created an artificial lung system that temporarily took over the function of his lungs. This device oxygenated his blood and removed carbon dioxide while maintaining stable circulation through his heart and body.
After removing the infected lungs, doctors observed improvements in the patient's condition: blood pressure stabilized, organ function recovered, and infection subsided. Two days later, donor lungs became available for transplantation. More than two years after surgery, the patient has returned to daily life with good lung function.
"Conventionally, lung transplant is reserved for patients who have chronic conditions like interstitial lung disease or cystic fibrosis," said Bharat. "Currently, people think if you get severe ARDS, you keep supporting them and ultimately the lungs will get better."
Analysis of the removed lungs revealed widespread scarring and immune damage at a molecular level—evidence that some cases of ARDS result in irreversible tissue injury.
"For the first time, biologically, we are giving molecular proof that some patients will need a double lung transplant; otherwise they will not survive," said Bharat.
At present this approach can only be carried out at specialized centers with advanced expertise and resources. Bharat expressed hope that future developments would lead to more standardized devices capable of sustaining patients awaiting transplants.
"In my practice, young patients die almost every week because no one realized that transplantation was an option," Bharat said. "For severe lung damage caused by respiratory viruses or infections, even in acute settings, a lung transplant can be lifesaving."
