How Surgeons Kept a Man With No Lungs Alive for Two Days

If you thought that things required to get through the day included a good night’s rest, a strong cup of coffee, and functioning lungs, you can strike the last item off the list. Surgeons in the U.S. kept a patient alive for two days with no lungs at all.

The patient breathed using an external lung system while he waited for a double lung transplant. The approach, say the surgeons, could help some other patients stuck in transplant limbo.

The amazing medical effort was documented in a case study published in the journal Med.

Living Without Lungs

computer monitor screen monitoring oxygen, blood, and temperature levels in a patient — The monitor screen, as it tracks oxygen, blood flow, and temperature, as the artificial lung system replaces the lung function of the infected lungs.
(Image Credit: Northwestern Medicine CC by SA)

The 33-year-old patient was admitted to the hospital with influenza B-associated acute respiratory distress syndrome (ARDS), an often-fatal condition that inflames the lungs and compromises their ability to pump oxygen into the blood. Over the course of six weeks, a worsening bacterial infection continued to attack his body.

“When the infection is so severe that the lungs are melting, they’re irrecoverably damaged. That’s when patients die,” said Ankit Bharat, a surgeon at Northwestern University and study co-author, in a statement. The patient’s kidneys and heart began to fail, too, and a double lung transplant was the only way forward.

The patient was caught between two opposing medical realities. They were too sick to accept a new pair of lungs, but their old lungs were pumping infection through the rest of their body. The patient seemed certain to die unless their lungs were removed.

“When there are no lungs, how do you keep the patient alive?” said Bharat.

Creating an Artificial Lung System

To save the patient’s life, the team improvised. They created an artificial lung system, located entirely outside the man’s body. The artificial system could pump oxygen into the man’s blood and pump out carbon dioxide, just like healthy human lungs. After both his lungs had been removed, the patient’s condition stabilized, and his other organs recovered from their infection. Two days later, the surgeons gave him a new pair of donated lungs. This all happened two years ago. Today, the patient has returned to normal life and has 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.”

But while Bharat’s team waited for their patient to beat the infection, they analyzed their explanted lungs at the cellular level using RNA sequencing, which provided insights into the biological processes occurring in the diseased organs. The lungs were deeply scarred and showed signs of immune damage, suggesting that they were past the point of recovery.

“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.

Changing the Future of Lung Transplants

The complexity, endeavor, and specialized equipment required by Bharat’s innovative technique mean it will remain restricted to the most well-stocked surgical centers for now. But Bharat hopes that future devices will become more standardized and open up this unusual medical intervention to those who need it to live.

“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.”

This article is not offering medical advice and should be used for informational purposes only

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