Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Zhou, Xuguo; Wang, Dongfang; Sumpter, Ryan; Pattison, Gary; Ballard-Croft, Cherry; Zwischenberger, Joseph B.

doi:10.1016/j.healun.2012.02.007

Cited by 21 publications

(20 citation statements)

References 19 publications

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“…This design is based on our active patent[28], which has been commercialized as the AvalonElite DLC. The AvalonElite DLC has been successfully applied in extracorporeal membrane oxygenation (ECMO) with proven long term (month) durability and high performance [29–31]. The A-Med jugular coaxial cannula was a two separate cannula system with the infusion cannula inside the drainage cannula.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

Condemi

Wang

Fragomeni

et al. 2016

Biocybernetics and Biomedical Engineering

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Objectives Our goal is to develop a double lumen cannula (DLC) for a percutaneous right ventricular assist device (pRVAD) in order to eliminate two open chest surgeries for RVAD installation and removal. The objective of this study was to evaluate the performance, flow pattern, blood hemolysis, and thrombosis potential of the pRVAD DLC. Methods Computational fluid dynamics (CFD), using the finite volume method, was performed on the pRVAD DLC. For Reynolds numbers <4000, the laminar model was used to describe the blood flow behavior, while shear-stress transport k-ω model was used for Reynolds numbers >4000. Bench testing with a 27 Fr prototype was performed to validate the CFD calculations. Results There was <1.3% difference between the CFD and experimental pressure drop results. The Lagrangian approach revealed a low index of hemolysis (0.012% in drainage lumen and 0.0073% in infusion lumen) at 5 l/min flow rate. Blood stagnancy and recirculation regions were found in the CFD analysis, indicating a potential risk for thrombosis. Conclusions The pRVAD DLC can handle up to 5 l/min flow with limited potential hemolysis. Further modification of the pRVAD DLC is needed to address blood stagnancy and recirculation.

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Section: Discussionmentioning

confidence: 99%

Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

Condemi

Wang

Fragomeni

et al. 2016

Biocybernetics and Biomedical Engineering

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“…Our previous patented ECMO DLC (Avalon Elite ™ , Rancho Dominguez, CA) has successfully proved this concept. 21 The AvalonElite DLC-ECMO circuit is much shorter with much lower resistance than the ECMO circuit with two single lumen cannulas. The AvalonElite DLC spares the femoral vein, enabling patient ambulation.…”

Section: Discussionmentioning

confidence: 99%

“…The CO 2 removal was calculated by multiplying the sweep gas flow rate and the outlet CO 2 concentration. The O 2 transfer was calculated according to the following formula 21 :

O_{italic 2} transfer = 1.34 \times hemoglobin \times 10 \times Δ O_{italic 2} sat \times Qb + 0.003 \times Δ {italicPO}_{2} \times Q .

Where ΔO 2 sat and ΔPO 2 were the change in blood O 2 saturation and in oxygen pressure across the gas exchange device, respectively.…”

Section: Methodsmentioning

confidence: 99%

Development of a Double-Lumen Cannula for a Percutaneous RVAD

et al. 2015

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The objectives were to design/fabricate a double lumen cannula (DLC) for a percutaneous RVAD (pRVAD), and to test the feasibility/performance of this pRVAD system. A 27 Fr DLC prototype was made and tested in 6 adult sheep. The pRVAD DLC was inserted into the right jugular vein, advanced through the superior vena cava (SVC)-right atrium (RA)-right ventricle (RV), and ended in the pulmonary artery (PA). A CentriMag pump and optional gas exchanger were connected to the DLC. Blood was withdrawn from RA, pumped through gas exchanger, and perfused PA. Maximal pumping flow was maintained for 2 hours. The pRVAD DLC was successfully deployed in all 6 sheep. In first 3 sheep, maximal average pumping flow was below 3 l/min because the DLC was advanced too far with drainage opening against RA side wall. In last 3 sheep with well positioned DLC, average maximal flow was above 3.5 l/min. The gas exchanger provided up to 230 ml/min CO2 removal and 174 ml/min O2 transfer. Our DLC-based pRVAD system is feasible for percutaneous right heart and respiratory assistance through a single cannulation. The pRVAD DLC can easily be placed prophylactically during LVAD implantation and removed as needed without additional open chest procedures.

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“…Patients ambulating on traditional ECMO require assistance by a team of nurses, perfusionists, and physical therapists during ambulation. Innovative ambulatory ECMO solutions are on the horizon, however, with encouraging results in animal studies . These devices—often referred to as “artificial lungs”—are compact and are specifically designed for mobility and long‐term use.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an autoregulatory ECMO system for total respiratory support in an acute ovine model

et al. 2020

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Extracorporeal membrane oxygenation (ECMO) has become a mainstay of therapy for patients suffering from severe respiratory failure. Ambulatory ECMO systems aim to provide long-term out-of-hospital respiratory support. As a patient's activity level changes, the required level of ECMO support varies with oxygen consumption and metabolic fluctuations. To compensate for such changes, an autoregulatory ECMO system (AR-ECMO) has been developed and its performance was evaluated as a proof of concept in an acute ovine model. The AR-ECMO system consists of a regular ECMO circuit and an electromechanical control system. A custom fuzzy logic control algorithm was implemented to adjust the blood flow and sweep gas flow of the ECMO circuit to meet the varying respiratory demand by utilizing two noninvasive sensors for venous oxyhemoglobin saturation and the oxygenator exhaust gas CO 2 concentration. Disturbance responses of the AR-ECMO to induced acute respiratory distress were assessed for six hours in four juvenile sheep cannulated with a veno-pulmonary artery ECMO configuration, including acute ventilator shutoff, ventilator step change (off-on-off), and forced desaturation. All sheep survived for the study duration. The AR-ECMO system was able to respond and maintain stable hemodynamics and physiological blood gas contents (SpO 2 = 96.3 % ± 4.29, pH 7.44 ± 0.09, pCO 2 = 38.9 ± 9.9 mm Hg, and pO 2 =237.9 ± 123.6 mm Hg) during simulated respiratory distress. Acceptable correlation between oxygenator exhaust gas CO 2 and oxygenator outlet pCO 2 were observed (R 2 = 0.84). In summary, the AR-ECMO system successfully maintained physiologic control of peripheral oxygenation and carbon dioxide over the study period, utilizing only measurements taken directly from the ECMO circuit. The range of system response necessitates an adaptable system in the setting of variable metabolic demands. The ability of this system to respond to significant disturbances in ventilator support is encouraging.Future work to evaluate our AR-ECMO system in long-term, awake animal studies is necessary for further refinement. K E Y W O R D Sartificial lung, autoregulatory control, extracorporeal membrane oxygenation, respiratory distress | 479 CONWAY et Al.

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Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Cited by 21 publications

References 19 publications

Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

Percutaneous double lumen cannula for right ventricle assist device system: A computational fluid dynamics study

Development of a Double-Lumen Cannula for a Percutaneous RVAD

Evaluation of an autoregulatory ECMO system for total respiratory support in an acute ovine model

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