Bilateral Pneumonectomy: Physiologic Consequences & Clinical Reality

Bilateral pneumonectomy is incompatible with life without immediate extracorporeal support (ECMO) or transplantation.

Immediate Physiologic Collapse

1. Anoxia: No gas exchange → PaO₂ plummets, PaCO₂ soars → unconsciousness in <1 min, brain death in 5–10 min
2. Right heart failure: Pulmonary vascular bed removed → ↑ RV afterload → acute cor pulmonale
3. Systemic hypotension → multi-organ failure

Clinical Context

• Never performed electively. Historical: attempted for diffuse malignancy/trauma — mortality ~100%.
• Modern: Lung transplantation (sequential bilateral) or VV-ECMO bridge are the only survival pathways.
• Single pneumonectomy is well-tolerated with compensation.

Ethical/Legal

Removing both lungs without immediate replacement constitutes fatal intervention. Not a viable clinical procedure.