title: Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung.
abstract: BACKGROUND
  Worsening of lung failure in patients awaiting a lung transplantation might lead to ventilation-refractory hypercapnia and respiratory acidosis. Most transplant centers consider pretransplantation extracorporeal membrane oxygenation as a contraindication for lung transplantation because of the poor outcome. We have, for the first time, applied the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation in patients with severe ventilation-refractory hypercapnia. We report on our initial experience.
  
  
  METHODS
  Between March 2003 and March 2005, 176 lung transplantations were performed, of which 60% were high-urgency lung transplantations. Twelve of the high-urgency recipients had severe ventilation-refractory hypercapnia and respiratory acidosis. These patients were connected to the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation.
  
  
  RESULTS
  The length of interventional lung assist NovaLung support was 15 +/- 8 days (4-32 days). PaO2, pH, and PaCO2 levels in arterial blood prior to interventional lung assist NovaLung implantation were 71 +/- 27 mm Hg, 7.121 +/- 0.1, and 128 +/- 42 mm Hg, respectively. Six hours after interventional lung assist NovaLung implantation, PaO2, pH, and PaCO2 levels had changed to 83 +/- 17 mm Hg (ns), 7.344 +/- 0.1 (P < .05), and 52 +/- 5 mm Hg (P < .05), respectively. Four patients died of multiorgan failure, 2 patients before and 2 after lung transplantation. Thus, 10 out of 12 patients were successfully bridged to lung transplantation, and 8 are still alive (1-year survival, 80%).
  
  
  CONCLUSIONS
  This report suggests that interventional lung assist NovaLung implantation is an effective bridge to lung transplantation strategy in patients with ventilation-refractory hypercapnia.
authors.affiliation: Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischer
authors.forename: Andre R
authors.initials: AR
authors.lastname: Simon
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Anna
authors.initials: A
authors.lastname: Meyer
authors.forename: Rene
authors.initials: R
authors.lastname: Tessmann
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gohrbandt
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Martin
authors.initials: M
authors.lastname: Strueber
mesh_terms: D000142:Acidosis, Respiratory / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D016040:Lung Transplantation; D011300:Preoperative Care; D012720:Severity of Illness Index; D012122:Ventilators, Mechanical