Bridge to lung transplantation through a pulmonary artery to left atrial oxygenator circuit

Background. There is no mechanical device available to support patients with end-stage lung failure for weeks and months until appropriate donor organs for lung transplantation are available. Methods. In a 38-year-old female patient with primary pulmonary hypertension a paracorporeal artificial lung (PAL) system was placed parallel to the pulmonary circulation with connections to the pulmonary artery and to the left atrium. The key component of the PAL was a low-resistance membrane oxygenator. Results. After institution, the PAL had a blood flow of 3.5 L/min and created a PaO2/fraction of inspired oxygen ratio of 270, while the oxygenator was provided with oxygen 3L/min. The pulmonary artery pressure declined by almost 50%. The PAL worked well over 62 days until appropriate donor lungs were available. With resuming more physical activity, an increased flow through the native lung augmented the fraction of unsaturated blood arriving at the left atrium, which mandated increasing oxygen flow to the PAL. Conclusions. The data obtained with this case encourage further research into PAL systems, which may hopefully serve as a bridge to lung transplant device in appropriate patients in the future.