Extracorporeal gas exchange, lung transplantation, and the artificial lung.

The potential for lung damage from mechanical ventilation may be much greater than has been realized in the past. Prior studies of extracorporeal support in adults were carried out after patients had been subjected to high airway pressure and hyperventilation for several days. The studies by Gatinoni supported by Kolobow would suggest that earlier application of extracorporeal gas exchange to remove CO2 may be more effective in salvaging the lung, particularly if applied before ventilator-induced lung damage has occurred. These challenging studies, combined with the successful application of extracorporeal support in infants, should stimulate new investigations of extracorporeal support in adult respiratory failure. Extracorporeal support may be a valuable adjunct to lung transplantation if transient pulmonary failure occurs following that operation. However, lung transplantation for acute respiratory failure in a patient who is being supported with ECMO is not recommended. The feasibiilty of an implantable lung has been demonstrated in animals for short periods of time. Continuing studies in this area should be encouraged, particularly before the establishment of a lungless animal preparation to determine some of the nonrespiratory functions of the lung.