New surgical method

Finally, breathing out again

The innovative use of an "artificial lung" (ECMO) with a twin-port cannula helped Gülahmad Sultanachmadov as his lung had to be operated. The method was documented as part of such an operation in this form for the first time in the world.
The interdisciplinary team of intensive care physician and senior physician Dr. med. Felix Gieble and the thoracic surgeon and senior physician Dr. med. Bassam Redwan and chief physician and private lecturer Dr. med. Servet Bölükbas saw their patient Gülahmad Sultanachmadov back in a good condition – and without the oxygen apparatus – during the follow-up examination.

Gülahmad Sultanachmadov could hardly breathe when he introduced himself at the HELIOS Clinic Attendorn to Dr. med. Michael Arattukulam. The lung had been so severely damaged due to chronic obstructive pulmonary disease (COPD) that it had resulted in an extreme pulmonary emphysema with formation of huge air pockets ("giant bulla"). In this disease, the diseased air sacs are enlarged such that the consumed air can no longer be exhaled. Many of the air sacs are completely destroyed and in extreme cases, large areas are formed which no longer work at all and overinflated the lung. These were already so big in Mr. Sultanachmadov that his heart and also the diaphragm, the most important breathing muscle, were pushed. An operation was inevitable and the patient was recommended to the "Lung Center in the Bergische region", the HELIOS Hospital Wuppertal.

If a person is to be operated on the lung, he must be placed under artificial respiration. Thus, during the operation, only one lobe of the lung works so that the other can be operated on. But what is to be done, when the lung itself is diseased and hence the respiration from one side is not enough?
 
At the Lung Center Wuppertal, the senior physician, Dr. med. Bassam Redwan has special experience with the so-called ECMO procedure. In a lung operation on patient with severely limited lung function, the extracorporeal lung support technique can be used in order to completely or partly replace the gas exchange, that is, oxygenation and removal of CO2. It is comparable to the so-called heart-lung machine during a heart operation. Though the technique is often used on new-born babies with still undeveloped lungs, in the case of adults, it is used only as the last resort in major surgeries or in patients with limited lung function.

Innovative combination with the dual cannula

In the ECMO procedure, the blood is normally withdrawn from one vein and again supplied to another part of the body. In the present case, the thoracic surgeons decided jointly with the intensive care physician to combine the ECMO with a dual cannula, which can remove blood as well as supply it back to the body - and only one puncture site is required for this.
 
Since oxygen uptake was still functioning to some extent in the other lobe of the lungs in Mr Sultanachmadov, it was mainly CO2 removal that needed to be done by the machine. Hence, the surgeons took a chance with the use of the twin-port cannula.
 
"We decided to use the new cannula in order to be gentle on the patient. And it worked", says Dr. Redwan pleased. He has gifted his patient 30 percent more lung function through the operation. "Earlier, Mr Sultanachmadov needed oxygen every day for several hours. That is no longer necessary now, his quality of life has improved enormously", says Dr. Redwan.
 
For him and his colleagues, it is always a great challenge to contrive the gentlest combination of surgical techniques. "We are always pleased when we succeed in bringing out the best of our options for the patient", says private lecturer Dr. Servet Bölükbas, Chief physician at the Clinic for Thoracic Surgery at the Bergische Lung Centre in Wuppertal. "This way we build our expertise further and enable a gentler operation for many lung patients."

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