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Surgeons Kept a Patient Alive for 48 Hours Without Lungs, Enabling a Double Transplant

A case report details a flow-adaptive total artificial lung that preserved heart circulation to bridge an otherwise unsalvageable ARDS patient to transplant.

Overview

  • Northwestern Medicine surgeons removed a 33-year-old patient's infected lungs in 2023 and sustained him on an externally configured total artificial lung for two days before a successful double lung transplant, according to a Med paper published January 29.
  • The system oxygenated blood, cleared carbon dioxide, and actively routed blood from the right to the left heart to maintain normal cardiac output, a function the team says distinguishes it from conventional ECMO.
  • The patient’s influenza-triggered ARDS was compounded by drug-resistant Pseudomonas necrotizing pneumonia, septic shock, and heart and kidney failure, but his hemodynamics and organ function recovered once the diseased lungs were removed.
  • Single-cell and spatial transcriptomic analysis of the explanted lungs showed widespread immune injury and end-stage fibrotic signatures, providing biological evidence that some severe ARDS cases are irreversible and warrant transplantation.
  • Researchers and outside experts describe the approach as a proof-of-concept feasible at highly specialized centers and call for registries, multicenter evaluation, biomarker development, and standardization before broader adoption.