Helping kids with severe respiratory failure survive until lung transplantation

May 6, 2013, American Association for Thoracic Surgery

Adults with end-stage respiratory failure and pulmonary hypertension requiring ECMO (extracorporeal membrane oxygenation) have been "bridged" toward lung transplantation with novel lung assist devices such as the Novalung. This and related devices work based on pumpless application of oxygenators. A presentation by David M. Hoganson, MD, and colleagues from Washington University School of Medicine in St. Louis at the Congenital Heart Disease Session of the 93rd AATS Annual Meeting describes the first time application of this technology to newborns and small children.

Neonates or small children with severe respiratory failure may be candidates for – if they survive long enough to receive the transplant. They may be placed temporarily on ECMO, but weaning from ECMO is difficult and outcomes are poor. Often children on ECMO are removed from the . New options are needed to support these children until they can receive a transplant or recover from .

"This case series demonstrates the feasibility of a new treatment option for these ," says Dr. Hoganson, a fellow in the Division of Cardiothoracic Surgery at Washington University School of Medicine. "Use of a paracorporeal lung assist device successfully supported four patients to recovery, lung transplantation, or past the average wait time for pediatric (27 days)."

Dr. Hoganson describes experiences with four young patients ranging in age from 23 days to 23 months. Two children presented with primary lung disease including alveolar capillary dysplasia; one patient with horseshoe lung with right pulmonary hypoplasia, pulmonary interstitial glycogenosis, and an atrioventricular canal defect; and the fourth with primary pulmonary hypertension. All patients had pulmonary hypertension. Patients were on ECMO for an average of eight days, and were supported by the oxygenator for five to 74 days (44 days average).

Using the new device, one patient was able to undergo a after five days of lung device support and one was weaned to medical management after 42 days of support. Two of the patients died, after 54 and 74 days of support.

"Anticoagulation management of these oxygenators in infants is challenging because of the low flow rates and a small cardiac structure, as well as the use of a metal right angle cannula in the left atrium," says Dr. Hoganson.

An aggressive anticoagulation regimen was adopted to counter the high risk of developing a blood clot. Despite efforts to optimize the balance between bleeding and thrombosis, three of four patients experienced strokes. To minimize the risk of clotting for the fourth patient, Dr. Hoganson describes a novel cannulation technique that was developed for left atrial blood return.

Paracorporeal support may also offer other benefits that ECMO does not. Two patients were able to be extubated for a majority of their time, which allowed the children the opportunity to interact better with their families and take oral feedings. They could participate in physical therapy and required less sedatives or narcotics.

Dr. Hoganson concludes, "Paracorporeal lung assist device support of neonates and young children has been demonstrated to be feasible in this early patient series. Continued optimization of anticoagulation and further refinement of cannulation strategies will hopefully make this therapy applicable to patients needing short to medium term lung support following respiratory decompensation."

Adds Pirooz Eghtesady, MD, PhD, senior author and chief of pediatric surgery at Washington University School of Medicine, "My colleagues and I are cautiously optimistic of this technology, based on its use in four unique patients with and elevated pulmonary artery pressures. More research is needed to see whether this technology can be more broadly applied to other young patients."

Explore further: New use of artificial lung device pioneered at University of Kentucky

More information: "Paracorporeal Lung Assist Devices as a Bridge to Recovery or Lung Transplant in Neonates and Young Children," by David M. Hoganson, Avihu Z. Gazit, Umar S. Boston, Stuart C. Sweet, R. Mark Grady, Charles B. Huddleston, Pirooz Eghtesady. Presentation at the 93rd AATS Annual Meeting. May 4-8, 2013, Minneapolis MN, during the Congenital Heart Disease Session on May 6, 4:15 PM CT. aats.org/annualmeeting/

Related Stories

New use of artificial lung device pioneered at University of Kentucky

August 4, 2011
Surgeons at the University of Kentucky on Aug. 3 announced that they were among the first to use artificial-lung technology to demonstrate the feasibility of a lung transplant, using a device invented by two university faculty ...

Extracorporeal membrane oxygenation as a bridge to lung transplantation

January 20, 2012
Extracorporeal membrane oxygenation (ECMO) support in awake, non-intubated patients may be an effective strategy for bridging patients to lung transplantation, according to a new study from Germany.

Washington University surgeons successfully use artificial lung in toddler

June 16, 2011
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.

UK HealthCare surgeons are first to perform novel procedures prior to transplant

October 31, 2011
Surgeons at UK HealthCare recently became the first ever to perform two specific procedures together as a bridge to lung transplantation. Wanda Craig, of Lexington, Ky., is the first patient in history to receive these procedures, ...

Anti-reflux surgery helps airway function both before and after lung transplant

September 19, 2011
Surgery to correct gastroesophageal reflux disease, or GERD, can preserve lung function in patients with end-stage pulmonary disease both before and after transplantation, according to a new study from the University of Pittsburgh ...

Critically ill flu patients saved with artificial lung technology treatment

January 17, 2013
In recent weeks the intensive critical care units at University Health Network's Toronto General Hospital have used Extra Corporeal Lung Support (ECLS) to support five influenza (flu) patients in their recovery from severe ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.