Surgeons Achieve Breakthrough in Lung Surgery
Surgeons at Northwestern Medical School in Chicago announced a remarkable feat last week: they managed to keep a critically ill patient alive for 48 hours after removing both lungs.
The patient, a 33-year-old from Missouri whose identity remains undisclosed, arrived at Northwestern Memorial Hospital in the spring of 2023 due to lung failure stemming from an influenza-related illness.
As his condition deteriorated into severe pneumonia and sepsis, he experienced a cardiac arrest, prompting the team to perform CPR, as detailed in a press release regarding the case.
Dr. Ankit Bharat, chief of thoracic surgery and executive director of the Canning Thoracic Institute at Northwestern Medicine, explained, “He had developed a lung infection that was resistant to all antibiotics, resulting in liquefaction of the lungs and the infection spreading to other areas of the body.” This necessitated the removal of his lungs to prevent further complications, although there was a significant risk of immediate heart failure.
“The lungs function as a ‘shock absorber’ for the right side of the heart,” Bharat remarked. “Without them, the heart must work against high resistance, which could lead to immediate failure.”
He also noted that if blood flow from the lungs to the left side of the heart was halted, there was potential for the left ventricle to collapse, risking the formation of fatal blood clots.
While the patient was on life support, the medical team created a “total oxygenator system” (TAL) that would manage gas exchange—supplying oxygen and removing carbon dioxide—to keep blood flowing to the heart until a transplant could be arranged.
“The key innovation here was maintaining the heart’s natural physiology,” Bharat said. “We designed a ‘flow-adaptive’ system that allowed the heart to control blood flow rather than relying on a machine.”
Bharat reported, “Remarkably, just one day after the lung removal, the patient’s condition began to improve as the infection diminished.”
After a 48-hour period, the patient stabilized enough to undergo a double lung transplant. Two years later, he returned to his regular activities.
Dr. Bharat confirmed, “The patient’s health is very good. His lung function is excellent, his heart is stable, and he is functionally independent.”
This was the first successful use of this specific type of system, according to the medical team.
Bharat emphasized, “Historically, attempts to remove a lung and create a bridge for transplantation have been rare due to challenges in managing blood flow and preventing blood clots.” He added that their system features a self-regulating ‘shunt’ to mimic normal lung function, ensuring the heart is protected and blood flow is maintained.
A case study published recently highlighted a “molecular analysis” of the removed lung, revealing extensive scarring. This finding reinforces the argument that, in severe cases of acute respiratory distress syndrome, transplantation can be the only feasible solution.
Looking ahead, researchers are hopeful that the TAL system may become a practical option for those awaiting lung transplants, particularly patients experiencing severe acute respiratory distress syndrome or necrotizing pneumonia.
Dr. Bharat noted, “The mortality rate for these patients exceeds 80%, and they’re often denied transplants due to their infection levels. This innovation offers a ‘clean slate’ by eradicating infection while stabilizing the patient for successful transplantation.”
He mentioned his aspirations to develop durable, implantable oxygenators that could serve as a long-term solution, not only as a bridge to transplantation but also for extended patient survival.
