In Vitro and In Vivo Feasibility Study for a Portable VV-ECMO and ECCO2R System

Abstract

Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for patients with chronic respiratory failure waiting for lung transplantation (LTx). The therapy inherent immobilization may result in fatigue, consecutive deteriorated prognosis, and even lost eligibility for transplantation. We conducted a feasibility study on a novel system designed for the deployment of a portable ECMO device, enabling the physical exercise of awake patients prior to LTx. The system comprises a novel oxygenator with a directly connected blood pump, a double-lumen cannula, gas blender and supply, as well as control and energy management. In vitro experiments included tests regarding performance, efficiency, and blood damage. A reduced system was tested in vivo for feasibility using a novel large animal model. Six anesthetized pigs were first positioned in supine position, followed by a 45° angle, simulating an upright position of the patients. We monitored performance and vital parameters. All in vitro experiments showed good performance for the respective subsystems and the integrated system. The acute in vivo trials of 8 h duration confirmed the results. The novel portable ECMO-system enables adequate oxygenation and decarboxylation sufficient for, e.g., the physical exercise of designated LTx-recipients. These results are promising and suggest further preclinical studies on safety and efficacy to facilitate translation into clinical application.

Refurbishment of Extracorporeal Life Support Oxygenators in the Context of In Vitro Testing

“…Prior, the relevance for long-term artificial lungs has been stated and a major part of the current research is focused on the prolongation of ECMO therapy and even intracorporeal lungs. [18][19][20][21][22][23][24][25][26][27] "On the horizon is the next 'Holy Grail,' the implantable artificial lung." 28 If the degeneration of artificial lungs cannot be entirely solved in the near future, an intermittent refurbishment protocol could be a bridging technology.…”