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Ann Thorac Surg 2009;88:352. doi:10.1016/j.athoracsur.2008.12.013
© 2009 The Society of Thoracic Surgeons
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Correspondence

Paracorporeal Artificial Lung Circuit as a Possibility for Bridge to Lung Transplantation

Thomas Puehler, MD, Alois Philipp, Christof Schmid, MD, PhD

Department Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, D-93053 Germany

(Email: thomas.puehler{at}klinik.uni-regensburg.de).

To the Editor:

We read with great interest the article by Broomé and colleagues [1], who reported a 38-year-old patient with acute lung failure caused by progressive acute alveolitis. After failure of medical therapy, lung-transplantation remained the only therapeutic option. Owing to progressive deterioration, venovenous extracorporeal membrane oxygenation (ECMO) became necessary, which was changed to a venoarterial ECMO after right ventricular failure and was maintained until successful transplantation [1]. Because no device for long-term support of patients with end-stage lung failure exists, ECMO is the most common and successful way to bridge those patients until transplantation.

Concepts of an artificial lung to shunt blood from the pulmonary vein to the left atrium have been tested in animal models but have not reached clinical practice. Temporary respiratory support with low-resistance membrane oxygenators driven by an arteriovenous pressure difference (Novalung, Hechingen, Germany) have demonstrated great benefit, especially in hypercapnic patients, but did not provide acceptable conditions for long-term use [2, 3].

We recently reported a 38-year-old woman who received paracorporeal artificial lung (PAL) support for 62 days as a bridge to lung transplantation. In this patient with severe pulmonary hypertension, cannulation of the pulmonary artery and the left atrium allowed long-term use of a membrane oxygenator. The PAL had a blood flow of 3.5 to 5 L/min and created a sufficient partial pressure of arterial oxygen/fraction of inspired oxygen ratio with 3 to 6 L/min oxygen. The system worked well, and the patient could be mobilized to walk around and go outside; however, an oxygenator exchange was necessary four times because of a decline in blood flow and oxygenation [4]. In our opinion, PAL is the way to go to bridge patients to lung transplantation and to mobilize patients in an intensive care unit. Although the concept of PAL is still in an early stage, it should be considered more often as an alternative to ECMO therapy.


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  1. Broomé M, Palmér K, Scherstén H, Frenckner B, Nilsson F. Prolonged extracorporeal membrane oxygenation and circulatory support as bridge to lung transplant Ann Thorac Surg 2008;86:1357-1360.[Abstract/Free Full Text]
  2. Reng M, Philipp A, Kaiser M, Pfeifer M, Gruene S, Schoelmerich J. Pumpless extracorporeal lung assist and adult respiratory distress syndrome Lancet 2000;356:219-220.[Medline]
  3. Flörchinger B, Philipp A, Klose A, et al. Pumpless extracorporeal lung assist: a 10-year institutional experience Ann Thorac Surg 2008;86:410-417.[Abstract/Free Full Text]
  4. Schmid C, Philipp A, Hilker M, et al. Bridge to lung transplantation through a pulmonary artery to left atrial oxygenator circuit Ann Thorac Surg 2008;85:1202-1205.[Abstract/Free Full Text]

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Michael Broomé
Ann. Thorac. Surg. 2009 88: 352-353. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., July 1, 2009; 88(1): 352 - 353.
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