A 2-year-old toddler, who was suffering idiopathic pulmonary hypertension or high blood pressure, was first in the world to get an artificial lung.
Owen Stark was given the artificial lung at St. Louis Children's Hospital under a severe condition of pulmonary hypertension, in which blood is prevented from entering the lungs because the arteries are too narrow.
The artificial lung 'breathes' outside the patient's body to add oxygen and remove carbon dioxide from the blood.
Approved only for adults, it 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.
"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," said Avihu Z. Gazit, a Washington University pediatric critical care physician.
Owen's pulmonary hypertension condition was so severe that in addition to medication, he was placed on a ventilator to force oxygen into his lungs. Physicians thought that he might 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," he added.
"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," said Gazit.
ECMO gives the heart and lungs time to recover and respond to medical treatment prior to a lung transplant.
After 16 days on ECMO, Owen's heart had recovered but his lungs had not. Since there were no lungs available for transplant, the surgeons decided to put him on the artificial lung, even though it had never been used on a child so young.
Post surgery, Owen had to be sometimes 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.
The surgery details are reported in the current issue of The Journal of Thoracic and Cardiovascular Surgery.