Artificial Lungs for Lung Failure

Naito, Noritsugu; Cook, Keith E.; Toyoda, Yoshiya; Shigemura, Norihisa

doi:10.1016/j.jacc.2018.07.049

Cited by 20 publications

(29 citation statements)

References 68 publications

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“…For instance, recently, in high‐volume centers, there has been a paradigm shift toward performing lung transplant in patients with lung allocation scores in the highest tertile and a softening of attitudes toward the use of respiratory support before lung transplantation, such as prior mechanical ventilation and extracorporeal lung support (ECLS) including extracorporeal membrane oxygenation (ECMO), as was reported elsewhere . In fact, accumulating evidence supports using ECMO and ECLS to treat lung failure and support patients before and after lung transplantation, and the success of ECLS in lung transplantation sheds a new light on expanding its use toward long‐term artificial respiratory support for advanced lung failure . This is a good example of how high‐volume transplant centers are pushing the envelope and paving the way to move forward, enabling progress in pulmonary medicine and translational science.…”

Section: How To Cope With This New Challenge As a Transplant Specialimentioning

confidence: 86%

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Shigemura

Toyoda

2019

Transpl Int

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Summary In aging populations, many patients have multiple diseases characterized by acceleration of the aging process including cardiovascular diseases, metabolic diseases, and chronic kidney disease. Remarkable progress in minimally invasive, interventional therapies, such as percutaneous coronary intervention and transcatheter aortic valve replacement has enabled patients who were previously not transplant candidates because of co‐existing problems to become potentially viable candidates for lung transplantation. Recently, we have observed an outstanding and steady increase in patients older 70 years of age with multiple comorbidities who are referred to our high‐volume center as potential candidates for lung transplantation. However, the impact of diseases characterized by an accelerated aging process and their treatments on transplant outcomes remains unclear. This review aims to highlight these challenges in the current era of lung transplantation, review the prior literature, and discuss future directions with a multidisciplinary view including translational research, transplant medicine, and surgery, as well as from a programmatic and administrative standpoint.

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Section: How To Cope With This New Challenge As a Transplant Specialimentioning

confidence: 86%

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Shigemura

Toyoda

2019

Transpl Int

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“…ECLS devices used as a temporary treatment for acute lung failure are increasingly being established as a bridge to lung transplant (Novalung iLA, Xenios AG, Heilbronn, Germany; Hemolung, ALung Technologies, Pittsburgh, PA, USA; HLS Set Advanced, Getinge GmbH, Sweden; Affinity NT, Medtronic, Eden Prairie, MN, USA) (Table 1). 27‐36 Nowadays, ECLS is being considered for awake and nonintubated patients to improve oxygenation and carbon dioxide (CO 2 ) removal, facilitate ambulation, and improve physical conditioning before transplant 37‐47 . Several programs have developed ambulatory capability for ECLS, which is now referred to as an “artificial lung.” Recent outcomes with ECLS bridging to lung transplant at experienced centers are equivalent to outcomes in high‐risk nonbridged patients 28,32‐35,48‐53 …”

Section: Existing Mechanical Devicesmentioning

confidence: 99%

“…Much effort remains in the fields of technology improvement, cannulation approaches, identifying appropriate patients for bridging, and optimizing their conditions 27,48,54 . Artificial lung support encompasses different technologies and strategic approaches.…”

Section: One Size Does Not Fit Allmentioning

confidence: 99%

“…Hypercapnia may be a critical problem for end‐stage chronic lung diseases such as chronic obstructive pulmonary disease, and appropriate extracorporeal carbon dioxide removal can reverse its pathophysiology 27,44,59‐62 . CO 2 removal in a gas exchange device is more efficient than oxygenation.…”

Section: One Size Does Not Fit Allmentioning

confidence: 99%

“…When CO 2 removal is the primary intention, the blood flow rates through the device do not need to be as high as when oxygenation is the primary intention, and smaller catheters could be placed in the patient. This leads to an unproven assumption that the use of smaller catheters and lower blood flow rates will create an improved safety profile 27,59 …”

Section: One Size Does Not Fit Allmentioning

confidence: 99%

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Artificial lungs––Where are we going with the lung replacement therapy?

et al. 2020

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Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device‐related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel‐based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell‐based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy.

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Ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation

Keshavamurthy

Bazán

Tribble

et al. 2021

Indian J Thorac Cardiovasc Surg

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Ambulatory extracorporeal membrane oxygenation (ECMO) has shown promise as a bridge to lung transplantation. The primary goal of ambulatory ECMO is to provide enough gas exchange to allow patients to participate in preoperative physical therapy. Various strategies of ambulatory ECMO are utilized depending upon patients’ need. A wide spectrum of ECMO configurations is available to tackle this situation. We discuss those configurations in this article.

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Artificial Lungs for Lung Failure

Cited by 20 publications

References 68 publications

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Elderly patients with multiple comorbidities: insights from the bedside to the bench and programmatic directions for this new challenge in lung transplantation

Artificial lungs––Where are we going with the lung replacement therapy?

Ambulatory extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation

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