Unapproved device buys time for new pair of lungs

WASHINGTON (AP) – Jon Sacker was near death, too sick for doctors to attempt the double lung transplant he so desperately needed.

His only chance: An experimental machine that essentially works like dialysis for the lungs.

But the device has not been approved by the Food and Drug Administration and there were none in the country. It would take an overnight race into Canada to retrieve a Hemolung.

Sacker rapidly improved as the device cleansed his blood of carbon dioxide – so much so that in mid-March, 20 days later, he got a transplant after all.

“That machine is a lifesaver,” Sacker said from the University of Pittsburgh Medical Center.

Sacker’s struggle highlights a critical void: There is no fully functioning artificial lung to buy time for someone awaiting a transplant, like patients who need a new heart can stay alive with an implanted heart pump or those with failing kidneys can turn to dialysis.

“It seems like it should be possible for the lung as well,” said Dr. Andrea Harabin of the National Institutes of Health.

NIH-funded researchers are working to develop wearable “respiratory assist devices” that could do the lungs’ two jobs – supplying oxygen and getting rid of carbon dioxide – without tethering patients to a bulky bedside machine.

It has proven challenging.

“The lung is an amazing organ for gas exchange. It’s not so easy to develop a mechanical device that can essentially replace the function of a lung,” said bioengineer William Federspiel of Pitt’s McGowan Institute for Regenerative Medicine, who helped invent the bedside Hemolung and is working on these next-step devices.

So when Sacker needed an emergency fix, Dr. Christian Bermudez, UPMC’s chief of cardiothoracic transplants, gambled on the unapproved Hemolung. “We had no other options,” he said.

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Cystic fibrosis destroyed Sacker’s own lungs. The Moore, Oklahoma, man received his first double lung transplant in 2012. He thrived until a severe infection last fall damaged his new lungs, spurring rejection. By February, he needed another transplant.

The odds were long. Donated lungs are in such short supply that only 1,923 transplants were performed last year, just 80 of them repeats, according to the United Network for Organ Sharing.

Still, the Pittsburgh hospital, known for tackling tough cases, agreed to try – only to have Sacker, 33, arrive too debilitated for an operation. A ventilator was providing adequate oxygen. But carbon dioxide had built to toxic levels in his body.

When a ventilator isn’t enough, today’s recourse is a decades-old technology so difficult that only certain hospitals, including Pittsburgh, offer it. Called ECMO, it rests the lungs by draining blood from the body, oxygenating it and removing carbon dioxide, and then returning it. Sacker was too sick to try.

“I didn’t see any other alternative other than withdrawing support from this young man,” Bermudez said.

Then he remembered the Hemolung, invented by Pittsburgh engineering colleagues as an alternative to ECMO.

It was designed to treat patients with a different lung disease, called COPD, during crises when their stiffened lungs retain too much carbon dioxide, Federspiel said.