Successful treatment of a severely injured soldier from Afghanistan with pumpless extracorporeal lung assist and neurally adjusted ventilatory support

BACKGROUND: Life-threatening acute lung injury due to combat and/or terror attacks is associated with high mortality. The successful management includes the use of “rescue” extracorporeal lung assist and early transport by aeromedical evacuation teams. AIMS: Description of the pre-hospital support of a severely injured soldier with a pumpless extracorporeal arterio-venous lung assist in critical hypercapnia/hypoxemia. METHOD: A British soldier suffered from severe gunshot injuries to the chest and abdomen in Afghanistan. After traumatic pneumonectomy, he developed critical hypercapnia/hypoxemia. He was mechanically ventilated and supported with a pumpless interventional extracorporeal lung assist (iLA, Novalung, Talheim, Germany) and transferred to Germany. RESULTS: A sufficient CO(2) extraction and improvement in oxygenation enabled the safe transportation and lung protective ventilation. Weaning from mechanical ventilation was promoted by the application of a new neurally adjusted ventilatory assist (NAVA). The patient recovered, and he left Germany in stable condition. CONCLUSION: Novel techniques in extracorporeal lung assist and in ventilatory support may help save lives even in disaster medicine.