Surgeons and critical care specialists at Northwestern Medicine have developed a total artificial lung (TAL) system that sustained a patient for 48 hours after the removal of both lungs, enabling a double-lung transplant. The case, published in the journal Med, outlines how the TAL system was designed to temporarily replace key lung functions while maintaining stable blood flow through the heart and body.
The patient, from Missouri, arrived at Northwestern Memorial Hospital on extracorporeal membrane oxygenation (ECMO), which provides advanced life support when the heart or lungs are unable to function adequately. After suffering influenza-associated lung failure that progressed to necrotizing pneumonia and sepsis, conventional treatments were no longer effective. “He had developed an infection of his lungs that just could not be treated with any antibiotics because it was resistant to everything,” said Ankit Bharat, MD, chief of thoracic surgery and executive director of the Northwestern Medicine Canning Thoracic Institute. “That infection caused his lungs to liquify and then continued to progress to the rest of his body.”
Typically, patients with acute respiratory distress syndrome (ARDS) are kept on prolonged life support in hopes that their lungs will recover. However, in this case, ongoing infection and inflammation originating from the lungs left no option but removal. Removal without immediate transplantation is risky because losing both lungs eliminates gas exchange and destabilizes circulation.
Dr. Bharat’s team addressed this by designing a TAL system capable not only of oxygenating blood but also supporting circulation in the absence of lungs. The system included a flow-adaptive shunt for balanced blood flow through the heart and dual pathways for draining and returning blood. To prevent displacement of the heart within an empty chest cavity, temporary internal supports such as saline-filled tissue expanders were used.
“Just one day after we took out the lungs, his body started to get better because the infection was gone,” Dr. Bharat said.
After 48 hours on the TAL system, donor lungs became available and surgeons performed a double-lung transplant. More than two years later, the patient has resumed daily activities with strong lung function.
The report also details molecular analysis of the removed lungs using single-cell and spatial transcriptomic techniques. Researchers found extensive scarring and immune-related damage consistent with irreversible disease; cells needed for repair were largely absent while scar-forming cells dominated tissue structure.
“With severe ARDS, the conventional strategy is to keep supporting the patient and hope the lungs improve,” said Dr. Bharat. “Using our approaches and data, we can show at the molecular level that some patients won’t recover unless they receive a double-lung transplant.”
Researchers believe these molecular findings may help develop biomarkers or decision tools for identifying when transplantation is necessary—especially in acute cases where time is limited.
“This strategy requires extensive expertise in transplantation, extracorporeal support, and round-the-clock multidisciplinary critical care,” Dr. Bharat noted. He added: “For severe lung damage caused by respiratory infections, even in acute settings, lung transplant can be lifesaving. Patients and families should know to ask about all available options.”
Northwestern Medicine operates as a leading academic health system based in Chicago that prioritizes high-quality clinical care along with education and research initiatives (https://news.nm.org/). It collaborates strategically on research projects while offering nationally recognized programs supporting physician well-being (https://news.nm.org/). The organization emphasizes community service through humanitarian awards reflecting its values (https://news.nm.org/) under its parent entity Northwestern Memorial HealthCare (https://news.nm.org/). Its mission centers on delivering world-class patient-focused care supported by ongoing innovation (https://news.nm.org/).
The pulmonology program at Northwestern Memorial Hospital has been ranked highest in Illinois for 14 consecutive years.
