ISSUE: AUGUST 2014 | VOLUME: 40:8
Lung Assistant Keeps Patients in Air as Bridge to Transplant
A portable device for inducing respiration in badly damaged lungs may offer hope for patients in remote areas who must travel long distances for a lung transplant, according to the results of a case study.
The outcome of the case, as well as other cases in which the device has been used, represents the first time the instrument has been used aboard a fixed-wing aircraft. The case further suggests that the device can be used successfully under the stresses of takeoff and landing in fixed-wing aircraft, and with minimal training, the researchers said.
The study, presented at the 2014 annual congress of the Society of Critical Care Medicine, reported the case of a 28-year-old woman in Northern Ireland, weighing roughly 60 kg (132 lb), with end-stage lung disease brought on by cystic fibrosis. She had been awaiting a lung transplant for six years, and had had seven aborted trips to the transplant center. Because extracorporeal membrane oxygenation (ECMO) was not available at the remote treatment center, the doctors procured a device called the Novalung Interventional Lung Assist membrane ventilator from Germany, where it is manufactured.
The device supported the patient for nearly 16 days, as she waited for a donor organ to become available. Given the remote location and the weather conditions at the time, doctors determined that the best option was to transport the patient by air from Belfast to Newcastle, a journey of about 200 miles. Once a lung became available, the staff loaded the patient onto an air portable stretcher, and dismantled the device into its constituent parts—including pump, circuit and control units—which they secured using a variety of clamps and ad hoc devices. Flying on a Piper Chieftain fixed-wing aircraft, the doctors and support staff delivered the patient directly to the operating room in Newcastle without incident.
Although the Novalung has been used for helicopter transport, this case represents the first time it was used in a fixed-wing aircraft, subjected to the forces of takeoff and landing. The case demonstrates that the Novalung is a viable option for supporting patients awaiting a lung transplant in remote areas where ECMO is not an option, according to George Gardiner, MBChB, lead clinician at the Critical Care Network in Northern Ireland, who led the medical team managing this patient.
“We found that it was actually easier to use, and easier to train our people on a novel technology, than we had hitherto believed possible,” he said.
The Novalung and similar devices also could offer an indirect psychological benefit to patients in remote areas, by allowing them to remain where they have a support network of friends and family until an organ is available, said Denis Hadjiliadis, MD, MHS, director of the Adult Cystic Fibrosis Program and member of the Lung Transplantation Program at the Hospital of the University of Pennsylvania, in Philadelphia.
“Sometimes it puts a lot of strain on families, to have people move far away,” Dr. Hadjiliadis said. “In this case, maybe they could have transported the patient earlier, but that might mean the patient would have to be alone at the transplant center, with a lot more difficulty, not having their support system around them. Keeping them in their local place, and then transporting them kind of helps from that perspective,” Dr. Hadjiliadis added.