U.S. servicemember survive having a lung removed downrange

Doctors say Griego — of Apache Troop, 1st Squadron, 75th Cavalry Regiment, 101st Airborne Division — is also the first U.S. servicemember in the Iraq and Afghanistan wars to survive having a lung removed downrange.

His journey back started with the brave actions of his fellow soldiers. Griego and his unit were securing a road in southern Afghanistan on Oct. 19 when Taliban fighters opened fire from a nearby building. Griego was shot in the chest, and blood spewed from a bullet wound under his right ribs. Sgt. Matt Casting and Sgt. Mark Reed stanched it, keeping Griego from hemorrhaging, the most common cause of combat death.

Then, amid the heated firefight, the unit’s medic, Spc. Allan Hughes, ran 650 meters to reach Griego, who was laboring to breathe because air was building in his lung cavity, putting pressure on his lungs to the point of near collapse. Hughes thrust a thick, long needle into Griego’s chest, relieving the pressure and saving his life yet again.

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Minutes later, Griego was evacuated to the Role 3 hospital in Kandahar. There doctors discovered a tiny wound near the left side of Griego’s neck. This told them that the bullet had torn through his chest cavity, likely injuring both lungs, said U.S. Navy Dr. (Cmdr.) Eric Elster, director of surgical services at the hospital.

They wheeled Griego into the operating room. Elster and a team of surgeons searched for the severed vessels that poured blood into Griego’s lungs. They stapled off the top of Griego’s left lung, stemming the bleeding there.

But his right lung was full of holes. Despite their best efforts to stop all the leaks, the doctors could not control the bleeding, Elster said. So the surgeons clamped off the blood flow to the right lung, ensuring that it would have to be removed later.

A CT scan showed the bullet’s path through Griego’s chest. It had punctured his right chest near his back and then ricocheted off his spine — somehow not injuring it — and out the top of his left neck.

“He did have injuries to both his lungs,” Elster said. “But this was kind of a lucky shot, in that he did not have any other injuries to his spinal cord or esophagus that would have magnified it.”

The next morning surgeons removed Griego’s right lung, a procedure rarely attempted downrange. They also called Landstuhl Regional Medical Center’s Lung Rescue Team, which flies to combat zones and retrieves servicemembers with serious lung injuries.

The lung team landed in Kandahar that afternoon and tried several different ventilators on Griego, attempting to force air into his remaining lung to make him stable for flight. But all the ventilators failed, and Dr. (Lt. Col.) Sandra Wanek, who led the combat evacuation mission, chose to use a portable heart-lung machine that performs a therapy called extracorporeal membrane oxygenation, or ECMO.

The device, about the size of a suitcase, forces the blood through an artificial membrane that lets in oxygen while taking out carbon dioxide — mimicking the trade-off that naturally takes place in the lungs. The machine worked even better than Wanek expected, and by the time the team landed at Landstuhl several hours later on Oct. 20, Griego’s condition had started to improve.

He was then flown to the university hospital in Regensburg, Germany, where doctors have particular expertise with the portable ECMO machine. Doctors there had also trained Wanek and her team how to use the device in July.

Developed in the 1980s as a way to save the lives of premature infants with underdeveloped lungs, ECMO was never formally approved as a therapy in the United States because the machine was used only as a last-ditch, life-prolonging measure. Recently, however, ECMO machines have been used to treat patients with lung failure, including H1N1 influenza patients, with better prognoses.

Maquet, the company that developed the portable ECMO machine, is trying to get it approved for broader use in the U.S., particularly with patients suffering lung or heart failure who need to be transported.

A ruling by the U.S. Food and Drug Administration is expected sometime next year, but Wanek said she knows what would have happened to Griego had he received same gunshot wound stateside.

“This happens to you in Los Angeles,” she said, “ and the mortality rate is about 70 percent.”

A ventilator, Wanek explained, pushes air into the lungs, but that process can further injure, or even kill, patients whose lungs are damaged and weak.

The ECMO machine bypasses the lungs entirely. At the Regensburg hospital, Griego was kept sedated as the machine controlled the oxygen and carbon dioxide in his bloodstream. His remaining lung was left to heal.

There, Peter Griego read to his son from several hunting magazines, telling him about the latest rifles and archery bows — unsure whether they would again go hunting for deer and elk in mountains a few hours from their home in Mesa, Ariz. A weak squeeze of the hand was the only indication that his son could hear him. But Griego’s remaining lung slowly recovered, and doctors started forcing it to take “baby breaths,” Wanek said.

“As the lung was doing better,” she said, “we were able to let the lung do a little more, and the machine do a little less.”

After more than two weeks at the Regensburg hospital, Griego was taken off the ECMO machine. He returned to Landstuhl, where his tracheotomy tube was also removed, allowing him to talk in whispers when his father held two fingers over his open windpipe.

In Landstuhl’s intensive care unit, Griego sat up for the first time Nov. 8. His 17-year-old brother, Peter Jr., placed headphones on his ears, letting him listen to a favorite ’90s hip-hop group, Atmosphere. Griego’s lips mouthed the words of the songs, and Griego squeezed his younger brother’s hand when he wanted the tune changed.

Wanek said she expected Griego to make a full recovery, “in that he will go home and live a normal life. He just needs to get used to having a lot less lung.”

Griego was eventually flown to Brooke Army Medical Center in San Antonio, where he began physical therapy. He regained the ability to speak on his own last week, and this week he will join his family at the Fisher House to eat turkey and celebrate Thanksgiving.

“It’s my favorite holiday because all of my family is there,” he said. “This time it’s going to be my immediate family and the wounded soldiers and their families. But I definitely think this Thanksgiving will mean the most to me.”

Afterward, his recovery will continue. His legs are weak, but he has started to walk with the help of a family member or a walker.

“I still get winded just sitting up. I yawn like a baby, and when I need to take a deep breath I can tell that it’s not all there,” he said of his missing lung.

None of the doctors have been able to tell Griego precisely what physical limitations he can expect, beyond acknowledging that he will likely not run a marathon anytime soon.

“I think everybody is still amazed that I made it,” he said. “And they are just as curious as me.”

The only family member still unaware of Griego’s injuries and miraculous recovery is his 4-year-old daughter, Rylie.

“I haven’t called her because I’m not sure what I want to tell her,” he said. “But her mother told me she says a prayer for her daddy and his Army buddies every night.”

robbinss@estripes.osd.mil
see more at
http://www.stripes.com/family-thankful-for-medical-innovation-and-for-a-soldier-s-survival-1.126242?localLinksEnabled=false

Artificial Lung Closer to Clinical Trial ?

Artificial Lung Closer to Clinical Trial


Clinical Trials
After nearly a decade at the drawing board, "We are looking at what we consider final design changes," Merz says. Clinical trials may get under way in one to two years. The National Institutes of Health recently granted Bartlett $4.8 million to continue the research.

Early animal studies have been promising. In the latest study, University of Texas researcher Joseph Zwischenberger, MD, tried out the BioLung on sheep whose lungs had been badly burned by inhaling smoke. Six of the eight sheep on the BioLung survived five days, whereas only one of six sheep on an external breathing machine survived that long.

Meanwhile, Bartlett has been testing the waters for future human trials. "What we wanted to do was see what the transplantation centers were thinking," he says. So he sent them a survey.

Thirty-one transplant centers completed the survey -- and those were responsible for 72% of all lung transplants in the United States in 1999. Most said they would like to see the BioLung studied in fewer than 25 animals for 30 days before beginning to test the device on humans. Almost all of them said they would support and participate in a clinical trial.

"The FDA would have the final word," Bartlett says. "This is just a start."

A one-month study on two dozen animals may seem hasty, but the situation is dire. Last year, 1,054 people received lung transplants, but 477 died on the waiting list. As of August this year, 3,797 people were still waiting to be matched to a donor.

Most of the transplant centers that responded to Bartlett's survey said the device should be tested first on people with idiopathic (meaning "of unknown cause") pulmonary fibrosis. Among the sickest of these patients, few survive longer than three months.

see more info at
http://www.webmd.com/lung/features/artificial-lung-closer-to-clinical-trial?page=2

ALung Technologies Closes on $14 Million Financing

ALung Technologies Closes on $14 Million Series A Financing

Developer of Innovative Respiratory Support Device Announces Financing to Support Clinical Trials and Product Commercialization.

PITTSBURGH--(BUSINESS WIRE)--ALung Technologies, Inc. today announced that the Company has closed a $14 Million Series A financing round. The investment will support ongoing clinical trials of the Hemolung™ Respiratory Assist System and its subsequent commercialization. The Company’s Hemolung device is expected to help many patients with acute respiratory failure to avoid intubation and invasive mechanical ventilation.

“We are very excited about the early results coming out of our clinical trial in Germany”

The Hemolung Respiratory Assist System is designed to remove carbon dioxide and deliver oxygen directly to the patient's blood via a small catheter, inserted into the jugular or femoral vein, similar to acute kidney dialysis. This treatment is expected to provide a significant benefit over intubation and mechanical ventilation, in that it will allow the patient to talk and eat, and avoid sedation, while giving the lungs the opportunity to heal.
“This financing will allow ALung to complete its clinical trial in Germany and subsequently commercialize the Hemolung System,” said Peter DeComo, Chairman and CEO of ALung. “The ability of the Company to secure this financing in the current economic climate reinforces the potential of the Hemolung technology to help patients heal more quickly while reducing the overall cost of healthcare.”
A pilot study of the device is currently underway in Germany to demonstrate the safety and performance of the device. A US-based pivotal trial to gain FDA clearance will follow. “We are very excited about the early results coming out of our clinical trial in Germany,” said Nicholas Kuhn, Chief Operating Officer at ALung. “We look forward to completing our clinical trial and introducing the Hemolung to physicians and patients in the near future.”
Eagle Ventures, Inc., a Pittsburgh-based private equity firm, led the financing. Participating in the round were Birchmere Ventures, a Pittsburgh-based early-stage venture capital firm, as well as new and existing individual investors.
ALung Technologies, Inc. is a Pittsburgh-based medical device company commercializing artificial lung devices for the treatment of respiratory failure. The Company’s Hemolung™ Respiratory Assist System is designed to replace or supplement the use of invasive ventilators for patients with acute respiratory failure. For more information about ALung and the Hemolung Respiratory Assist System, please visit http://www.alung.com.

Contacts

ALung Technologies
Scott Morley, +1 412-697-3370
Vice President of Marketingsmorley@alung.com

creating artificial alveolus

This ersatz lung, no bigger than a multivitamin, could represent a new pharmaceutical testing method.

On it, researchers have created an artificial alveolus, one of the sacs in the lungs where oxygen crosses a membrane to enter the body's blood vessels. A polymer sheet that stands in for the membrane is in the blue strip. On one side of the sheet, blood-vessel cells mimic a capillary wall; on the other, lung-cancer cells mimic lung epithelial cells.

Scientists have tested the chip's immune response, and it behaves just like real tissue would, a first step to having lifelike organ systems on which drugs can act. The chip's primary developer, biomedical engineer Dongeun (Dan) Huh of Harvard University, hopes that within two years, the chip will succeed in mimicking the process by which the lungs swap oxygen for carbon dioxide. Huh would like to create a suite of artificial organs to be used in cosmetics testing and pharmaceutical safety trials.

Generating artificial alveolus sounds like a first in building a complete replacement lung.

artificial alveolus,lung replacement

This post by Victor Zapana originally appeared at Popular Science.

Making a Lung Replacement

Making a Lung Replacement

National Institutes of Health Research Matters

Hot on the heels of progress toward a liver transplant substitute, researchers have made transplantable lung grafts for rats. The accomplishment could pave the way for the development of an engineered human lung.

Lungs have a limited ability to regenerate. The primary therapy for severely damaged lungs is currently lung transplantation—surgery to remove the lung and replace it with a healthy lung from a deceased donor. However, lung transplants are limited by the small number of donor organs available—not much more than 1,000 per year.

To be successful, an artificial lung would need to retain the complex branching geometry of the lung’s airways. It would also require a large network of small blood vessels to transport oxygen and nutrients throughout the structure. Decellularization—the process of removing cells from a structure but leaving a scaffold with the architecture of the original tissue—has shown some success in other organs, including heart and liver. A team of researchers led by Dr. Laura Niklason of Yale University set out to build on this recent progress and develop a similar approach for lungs. Their work was supported by NIH’s National Heart, Lung and Blood Institute (NHLBI) and National Institute of General Medical Sciences (NIGMS).

The researchers harvested lungs from adult rats. Treating the lungs with a mild detergent solution for 2 to 3 hours removed the cells but left the lung architecture intact, as reported in the early online edition of Science on June 24, 2010. A careful analysis showed that a matrix of proteins remained behind to hold the lung’s shape.

To see if they could repopulate the matrix with cells and engineer a functional lung, the researchers injected endothelial cells into the blood vessels and epithelial cells into airways. They kept the matrix for up to 8 days in a novel bioreactor that was designed to mimic the pressure changes and ventilation a lung would experience. The researchers found that the cells reseeded the surfaces of the matrix in their appropriate locations. This finding suggests that the decellularized matrix maintains cues for the cells to attach and thrive.

The researchers tested the engineered lungs in rats for short time intervals (45-120 min) and found that the lungs inflated with air, with only some modest bleeding into airways. Most importantly, the lungs successfully exchanged oxygen and carbon dioxide like natural lungs.

To see whether their method might apply to human tissues, the researchers got human lung segments from a tissue bank. They were able to decellularize the tissues while preserving their architecture. They then reseeded the matrices with epithelial and endothelial cells and found that they adhered at their appropriate locations. This result supports the idea that the approach holds promise for human lung tissue.

“We succeeded in engineering an implantable lung in our rat model that could efficiently exchange oxygen and carbon dioxide, and could oxygenate hemoglobin in the blood. This is an early step in the regeneration of entire lungs for larger animals and, eventually, for humans,” says Niklason. She notes that years of research with adult stem cells will likely be needed to develop ways to repopulate lung matrices and produce fully functional lungs for people.

—by Harrison Wein, Ph.D.

Related Links:
Lung Transplant:

http://www.nhlbi.nih.gov/health/dci/Diseases/lungtxp/lungtxp_whatis.html

click to see more info news on lung transplants and Lung Replacements