Friday, December 18, 2009

Portable artificial lung keeps patient alive for transplant

In addition to this article about bridge-to-transplant devices, also read my previous post about how surgeons at Toronto General Hospital (TGH) used the Novalung to save the life of a 16-year-old girl. The German-made machine is hooked up to both of the patient's legs. Blood is pumped from one leg and into a machine that removes the carbon dioxide, and re-oxygenates the blood, before it goes back into the body through the other leg. The machine essentially temporarily replaces the patient's lungs when they fail.

By R&

A 50-year-old former marathon runner with end-stage cystic fibrosis became one of the few in the world and the first in New York to use a new portable artificial lung to extend her life while waiting for a lung transplantation.

A standard respiratory ventilator was no longer effective at keeping the patient alive because her lungs had become too diseased.

Administered by the transplant team at NewYork-Presbyterian Hospital/Columbia University Medical Center, the device provided oxygen to the patient without her needing to rely on a ventilator. Bypassing her lungs, it oxygenated her blood directly through a two-way connection to a vein in her chest.

"The portable ECMO device, which works like an artificial lung, saved this woman's life," says Dr. Matthew Bacchetta, the thoracic surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center who led the transplant surgery. He is also assistant professor of surgery at Columbia University College of Physicians and Surgeons. "By connecting her to this machine, she was able to get the oxygen her body desperately needed. At the same time, she was able to eat, walk around, even talk on her own. As a result, she regained the strength needed to undergo a major surgery. This was a huge factor in making her transplant surgery a success."

The artificial lung is a state-of-the-art technology first developed in the early 1980s for neonatal care. Known as ECMO (extracorporeal membrane oxygenation), the machine oxygenates blood by pumping blood in and out of multiple tubes connected to a patient. A "membrane oxygenator" imitates the gas exchange process of the lungs, removing carbon dioxide and adding oxygen.

The artificial lung used for this patient at NewYork-Presbyterian/Columbia is constructed of components made by companies in the United States and Germany. A notable feature is a special cannula, or tube, that allows for a single connection, as opposed to the standard two connections, between the patient and the machine. This innovation makes it possible for patients to walk around with the portable oxygenator.

A standard respiratory ventilator requires patients to be sedated with a tube inserted in the mouth to oxygenate the patient's own lungs. In addition, patients on respirators are at risk for pneumonia, severe systemic infection, multi-organ failure and death.

"Just as left ventricular assist devices have saved the lives of countless patients with heart failure, we expect this machine may do the same for lung patients," Dr. Joshua R. Sonett, chief of general thoracic surgery and surgical director of the lung transplant program at NewYork-Presbyterian Hospital/Columbia University Medical Center and professor of clinical surgery at Columbia University College of Physicians and Surgeons. "And as the technology further develops, we might even see portable artificial lungs used as a longer-term treatment for some patients not eligible for transplantation."

Cystic Fibrosis
Cystic fibrosis is ranked as one of the most widespread life-shortening genetic diseases. The lung disease results from clogging of the airways due to mucosa build-up, which causes inflammation. Inflammation and infection cause injury and structural changes to the lungs, leading to a variety of medical problems. Respiratory failure is the most common cause of death.

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