First artificial lung procedure on Irish child

Doctors at Temple Street children's hospital in Dublin have performed the first artificial lung procedure in Ireland on a child who later went on to have a successful lung transplant in the UK.

The highly complex and risky procedure was also the first time that anyone in Britain or Ireland, child or adult, was fitted with an artificial lung as a bridge to a later lung transplant.

The teenager who received the groundbreaking procedure and the later transplant is now back at home and doing very well, according to Dr Kevin Carson, director of the paediatric intensive care unit at the Dublin hospital.

The girl, who has cystic fibrosis, had reached end-stage respiratory failure and was falling into unconsciousness because of high levels of carbon dioxide in her blood when her mother gave the go-ahead for the procedure last April. She couldn’t be put on a ventilator or intubated as this would have increased the risk of infection and made her sicker, meaning she would lose her place on the transplant waiting list.

Nova lung
The procedure, which took one hour to complete, involved fitting an artificial device known as a Nova lung which can remove carbon dioxide from the blood and oxygenate it outside the body. It works through the insertion of a 1cm-wide catheter in the thigh arteries. Blood is then run through a cell with a large surface area membrane, using the heart as a pump, and the carbon dioxide is removed.

Nova lungs have been used to keep adults alive, for as long as 180 days in the case of some patients treated at the Mater hospital. However, this was the first time the lung, which is about the size of a bag of sugar, was used on a child. The risks involved include haemorrhage, infection, loss of blood supply to the limbs, stroke and death, so it needs to be carried out by a skilled intensivist.

Social media
Once the lung was fitted, the girl quickly regained consciousness and was well enough to relay the news to friends on social media the following day, Dr Carson said. She was transferred to hospital in Newcastle two days later to await a transplant.

By chance, a similarly sized lung became available the following day and this was transplanted to the girl immediately. This operation too went well and the girl returned to Ireland six weeks later. She is currently at home and on long-term medication.

Transplanted lungs deteriorate more quickly than other organs and there is the ongoing threat that the body could reject the transplanted organ. However, the transplanted organ can be expected to function for up to six years.

Dr Carson said it would be hard to justify setting up a wider transplantation programme for children in Ireland on cost grounds, given the small number of children involved. At the end of last year, a handful of children were waiting for heart, lung or liver transplants and over 20 were waiting for a kidney.