Surgeons at Northwestern University performed a groundbreaking procedure, keeping a critically ill patient alive for 48 hours without lungs using a total artificial lung (TAL) system. This allowed the patient to receive a double lung transplant, marking a potential shift in how severe respiratory failure is treated.
The Case: Rapid Lung Failure
In spring 2023, a 33-year-old man developed influenza-associated lung failure that quickly escalated into pneumonia, sepsis, and acute respiratory distress syndrome (ARDS). His lungs deteriorated to the point where they were beyond recovery, and even antibiotic treatment proved ineffective.
The standard approach of mechanical ventilation wouldn’t work because the lungs were the source of the problem. Removing both lungs (bilateral pneumonectomy) would usually lead to heart failure due to disrupted blood flow. The patient was facing near-certain death either way.
The Total Artificial Lung Solution
To circumvent this, the surgical team used a TAL system – an external device designed to oxygenate blood as if lungs were present. This TAL system was improved with dual blood flow channels and a flow-adaptive shunt, stabilizing blood flow and protecting the heart.
The device was enough to keep the patient alive long enough for his body to recover from the initial infection and become viable for a lung transplant. Once the damaged organs were removed, recovery began.
Beyond Conventional Wisdom
The medical team confirmed through molecular analysis that the patient’s lungs were beyond saving. The severe scarring and immune damage meant transplantation was the only solution. This is a departure from current practice, where severe ARDS is usually treated with long-term life support, hoping the lungs will recover.
“Currently, people think if you get severe ARDS, you keep supporting them and ultimately the lungs will get better.”
– Ankit Bharat, Thoracic Surgeon
The patient received donor lungs and has since made a full recovery. The success of this procedure suggests that lung transplants could be considered earlier in cases of acute, irreversible respiratory failure.
Implications for Future Treatment
While TAL systems are currently limited to specialized centers, the innovations applied here—the improved blood flow management—could be incorporated into standard devices. This would make the approach more accessible and potentially save lives. The case highlights a gap in medical thinking: severe lung damage from infections is often treated with prolonged support when transplantation could be a viable, lifesaving option.
The ability to keep a patient alive without lungs for nearly two days demonstrates that aggressive intervention – including early consideration of transplantation – can succeed where traditional methods fail.
