Featured Research

from universities, journals, and other organizations

Surgeons successfully use artificial lung in toddler

Date:
June 17, 2011
Source:
Washington University School of Medicine
Summary:
Two-year-old Owen Stark came to hospital in the summer of 2010 near death from heart failure and dangerously high blood pressure in his lungs. Physicians knew they had to act fast to save his life. They made several strategic and innovative decisions that led to the first successful use of an artificial lung in a toddler.

Two-year-old Owen Stark came to St. Louis Children's Hospital in the summer of 2010 near death from heart failure and dangerously high blood pressure in his lungs.

Washington University physicians and surgeons at St. Louis Children's Hospital knew they had to act fast to save his life. They collaborated to make several strategic and innovative decisions that led to the first successful use of an artificial lung in a toddler.

Their efforts are reported in the June 2011 issue of The Journal of Thoracic and Cardiovascular Surgery.

The artificial lung, made by Novalung of Germany, "breathes" outside the patient's body to add oxygen and remove carbon dioxide from the blood. It is approved only for adults and has been used to treat severe pulmonary infections or as a bridge to lung transplantation. The lung works without a pump, using the body's natural heartbeat to circulate blood.

Owen was transported to St. Louis Children's Hospital in full heart failure from abnormally high blood pressure in the lung's arteries. In this rare condition, called pulmonary hypertension, blood is prevented from entering the lungs because the arteries are too narrow. This causes the right side of the heart, which pumps blood through the lungs, to work harder than normal and become enlarged, which leads to heart failure.

Avihu Z. Gazit, MD, a Washington University pediatric critical care physician, was the first to treat Owen at St. Louis Children's Hospital. Initial tests showed that the right ventricle of Owen's heart was extremely large, compressing the left side of his heart and creating severe high blood pressure in the lungs, an often fatal condition with no known cause.

Typically, pulmonary hypertension is first treated with medication, Gazit says. However, Owen's condition was so severe that in addition to medication, he was placed on a ventilator in an attempt to force oxygen into his lungs. Physicians thought Owen may eventually need a lung transplant.

"We hoped the ventilator would allow us to get him well enough that he wouldn't need to be put on a heart-lung machine," Gazit says. "But 24 hours later, we knew that wouldn't be the case, and we had to make the decision to go forward with the heart-lung machine called ECMO (extracorporeal membrane oxygenation). We knew that his chances of survival were getting smaller and smaller."

ECMO gives the heart and lungs time to recover and respond to medical treatment prior to a lung transplant. However, it comes with a high rate of complications, including bleeding, blood clots, infection and stroke, and carries a high mortality rate in patients who go on to have a lung transplant. Complications become more severe the longer a patient is on the machine, especially after 10-14 days, Gazit says.

After 16 days on ECMO, Owen's heart had recovered but his lungs had not. Since there were no lungs available for transplant, Owen's physicians knew they didn't have a lot of time. So the team, led by Charles B. Huddleston, MD, professor of surgery and a cardiovascular surgeon at St. Louis Children's Hospital; Stuart C. Sweet, MD, associate professor of pediatrics and a lung transplant surgeon; Gazit; and R. Mark Grady, MD, associate professor of pediatrics and director of the pediatric pulmonary hypertension program, decided to put Owen on the artificial lung, even though it had never been used on a child so young.

After getting emergency approval from the U.S. Food and Drug Administration and from Washington University's Institutional Review Board, Huddleston moved Owen from ECMO to the artificial lung in an innovative procedure without the need for a cardiopulmonary bypass.

The Novalung artificial lung is a small box about the size of a lunchbox that is attached through a shunt created between the main pulmonary artery and the left atrium of the heart.

"This case was very interesting and challenging from a physiological standpoint," Gazit says. "We had to determine what to do with Owen's lungs -- do we support him and wait for a lung transplant or do we work to improve the lungs to get him off of the artificial lung? We had to think about this every step of the way to form an approach."

Occasionally Owen had to be taken off of the artificial lung to have parts of the circuit changed. Initially his blood pressure and oxygen levels dropped significantly, but over time, his ability to sustain adequate oxygen levels improved. Another indicator for improvement was the increased blood flow through Owen's lungs rather than through the device.

Owen was on the artificial lung for 23 days when he accidentally kicked off one of the device's connectors. This resulted in Owen having a stroke and required swift action. However, when Owen was taken to the operating room to reconnect the device, Huddleston found that Owen's lungs had healed enough to allow adequate blood flow on their own.

"Owen was able to come off of the artificial lung," Gazit says. "We had no idea that we'd be able to get him off of the device before a transplant. It showed us that everything we did was the right thing."

"It is important to mention that our success is the result of a major collaborative effort," Gazit says. "Owen survived because of the dedication and hard work of our nursing staff, respiratory therapists and perfusionists."

A year later, Owen continues to take medication for pulmonary hypertension and so far has been able to avoid a lung transplant, says Stuart C. Sweet, MD, medical director of the Pediatric Lung Transplant Program at St. Louis Children's Hospital.

This experience with the artificial lung gives the medical community an option to manage young children with similar illnesses and support them prior to a transplant, Gazit says.

"We would like to be a part of or lead a trial," he says. "It requires a multi-institutional effort and we really hope that all of the large lung transplant centers will join us in this effort."


Story Source:

The above story is based on materials provided by Washington University School of Medicine. The original article was written by Beth Miller. Note: Materials may be edited for content and length.


Journal Reference:

  1. Gazit, Avihu Z., Sweet, Stuart C., Grady, R. Mark, Huddleston, Charles B. First experience with a paracorporeal artificial lung in a small child with pulmonary hypertension. J Thorac Cardiovasc Surg, 2011 141: e48-50 [link]

Cite This Page:

Washington University School of Medicine. "Surgeons successfully use artificial lung in toddler." ScienceDaily. ScienceDaily, 17 June 2011. <www.sciencedaily.com/releases/2011/06/110616193733.htm>.
Washington University School of Medicine. (2011, June 17). Surgeons successfully use artificial lung in toddler. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2011/06/110616193733.htm
Washington University School of Medicine. "Surgeons successfully use artificial lung in toddler." ScienceDaily. www.sciencedaily.com/releases/2011/06/110616193733.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Xtreme Eating: Your Daily Caloric Intake All On One Plate

Xtreme Eating: Your Daily Caloric Intake All On One Plate

Newsy (July 30, 2014) The Center for Science in the Public Interest released its 2014 list of single meals with whopping calorie counts. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins