Background
Conventional extracorporeal membrane oxygenation (ECMO) is cumbersome and is associated
with high morbidity and mortality. We are currently developing the Pittsburgh Ambulatory
Assist Lung (PAAL), which is designed to allow for ambulation of lung failure patients
during bridge to transplant or recovery. In this study, we investigated the in vitro
and acute in vivo performance of the PAAL.
Methods
The PAAL features a 1.75-inch-diameter, cylindrical, hollow-fiber membrane (HFM) bundle
of stacked sheets, with a surface area of 0.65 m2 integrated with a centrifugal pump. The PAAL was tested on the bench for hydrodynamic
performance, gas exchange and hemolysis. It was then tested in 40- to 60-kg adult
sheep (n = 4) for 6 hours. The animals were cannulated with an Avalon Elite 27Fr dual-lumen
catheter (DLC) inserted through the right external jugular into the superior vena
cava (SVC), right atrium (RA) and inferior vena cava (IVC).
Results
The PAAL pumped >250 mm Hg at 3.5 liters/min at a rotation speed of 2,100 rpm. Oxygenation
performance met the target of 180 ml/min at 3.5 liters/min of blood flow in vitro,
resulting in a gas-exchange efficiency of 278 ml/min/m2. The normalized index of hemolysis (NIH) for the PAAL and cannula was 0.054 g per
100 liters (n = 2) at 3.5 liters/min, as compared with 0.020 g per 100 liters (n = 2) for controls (DLC cannula and a Centrimag pump). Plasma-free hemoglobin (pfHb)
was <20 mg/dl for all animals. Blood left the device 100% oxygenated in vivo and oxygenation
reached 181 ml/min at 3.8 liters/min.
Conclusion
The PAAL met in vitro and acute in vivo performance targets. Five-day chronic sheep
studies are planned for the near future.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Seventh INTERMACS annual report: 15,000 patients and counting.J Heart Lung Transplant. 2015; 34: 1495-1504
- Artificial lung: bench toward bedside.ASAIO J. 2004; 50: 2-5
- The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation.Intensive Care Med. 2011; 37: 1932-1941
- Mechanical ventilation as a therapeutic tool to reduce ARDS incidence.Chest. 2015; 48: 1396-1404
- Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era.Intensive Care Med. 2011; 38: 210-220
- Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation.J Thorac Cardiovasc Surg. 2010; 139: 137-139
- Artificial lungs: are we there yet?.Thorac Surg Clin. 2015; 25: 107-113
- ECMO as bridge to lung transplant.Thorac Surg Clin. 2015; 25: 17-25
- Skeletal muscle force and functional exercise tolerance before and after lung transplantation: a cohort study.Am J Transplant. 2008; 8: 1275-1281
- First experience with the new portable extracorporeal membrane oxygenation system Cardiohelp for severe respiratory failure in adults.Perfusion. 2012; 27: 150-155
- Evolution of the extracorporeal life support circuitry.Artif Organs. 2010; 34: 869-873
- Wang-Zwische double lumen cannula—toward a percutaneous and ambulatory paracorporeal artificial lung.ASAIO J. 2008; 54: 606-611
- Early mobilization of LVAD recipients who require prolonged mechanical ventilation.Tex Heart Inst J. 2006; 33: 130-133
- Mobilization of patients on venovenous extracorporeal membrane oxygenation support using an ECMO helmet.Intensive Care Med. 2014; 40: 1595-1597
- Artificial lung basics.Organogenesis. 2011; 7: 23-27
Madhani SP, Frankowski BJ, Federspiel WJ. Fiber bundle design for an integrated wearable artificial lung [e-pub ahead of print]. ASAIO J. http://dx.doi.org/10.1097/MAT.0000000000000542. Accessed March 17, 2017.
Maquet HLS Set Advanced Flyer. https://www.maquet.com/int/products/hls-set-advanced/. Accessed January 19, 2017.
ISO 7199:2009. Cardiovascular implants and artificial organs—blood-gas exchangers (oxygenators); 2009.
ASTM F1841-97. Standard practice for assessment of hemolysis in continuous flow blood pumps; 2013.
- Contribution to the in vitro testing of pumps for extracorporeal circulation.J Thorac Cardiovasc Surg. 1967; 54: 22-29
- Blood trauma induced by clinically accepted oxygenators.ASAIO J. 2001; 47: 492-495
- A novel wearable pump-lung device: in vitro and acute in vivo study.J Heart Lung Transplant. 2012; 31: 101-105
- Design and in vitro assessment of an improved, low-resistance, compliant thoracic artificial lung.ASAIO J. 2012; 58: 583-589
- Hollow fiber membrane modification with functional zwitterionic macromolecules for improved thromboresistance in artificial lungs.Langmuir. 2015; 31: 2463-2471
Article info
Publication history
Published online: March 04, 2017
Identification
Copyright
© 2017 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
