Thirty-Day In-Vivo Performance of a Wearable Artificial Pump-Lung for Ambulatory Respiratory Support

Wu, Zhongjun J.; Zhang, Tao; Bianchi, Giacomo; Wei, Xufeng; Son, Ho Sung; Zhou, Kang; Sánchez, Pablo G.; García, José Pérez; Griffith, Bartley P.

doi:10.1016/j.athoracsur.2011.08.076

Cited by 34 publications

(23 citation statements)

References 20 publications

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“…A long-term ambulatory PAL has been developed by another group; however, that PAL system requires an open chest surgery with direct cannulation to the heart (atrium) and anastomosis to the main PA. 10 This major invasive surgery will have a significant and negative impact on the really sick patient. The major difference distinguishing our PAL system from others is the percutaneous, one-site venous PAL installation for efficient respiratory support, eliminating the major invasive surgery.…”

Section: Discussionmentioning

confidence: 99%

Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Zhou

Wang

Sumpter

et al. 2012

The Journal of Heart and Lung Transplantation

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Background Conventional ECMO is bulky/non-ambulatory and requires multiple blood transfusions. We hypothesized that a percutaneous, paracorporeal artificial lung (PAL) could be established through a single venous cannulation to provide long-term ambulatory respiratory support. Methods Our PAL system was tested in 11 healthy sheep. Avalon Elite™ DLC, inserted through right jugular vein into SVC, RA and IVC, was connected to a CentriMag pump and compact hollow fiber gas exchanger, forming a short circuit PAL system. All sheep were moved to ICU and were ambulatory following anesthesia recovery. Hemodynamics and device performance were measured daily. Results The ambulatory PALs were successfully established in all 11 sheep. The sheep were awake, ate and moved freely in the metabolic cage with no need of artificial nutrition and blood transfusion. All sheep had stable hemodynamics with 2 L/min of average circuit flow, above 9.2 g/dl of Hgb levels throughout the experiment. A progressive decrease of O2 transfer and CO2 removal capacity was observed. The sheep were euthanized between 10–24 days for the reasons of bleeding (n=2), gas exchanger failure (n=6), and DLC issues (n=3). Conclusions We successfully established up to 24 days long-term ambulatory PAL in 11 animals using our patented DLC through a single-site percutaneous venous cannulation. However, critical bleeding/thrombosis formation and gas exchanger durability remain two major challenges for long term ambulatory PAL.

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Section: Discussionmentioning

confidence: 99%

Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Zhou

Wang

Sumpter

et al. 2012

The Journal of Heart and Lung Transplantation

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“…At present, the long-term use of ECMO systems can only be tested in in vivo models, which is either an animal model or a treated patient, for approximately 30 days. 10,11 Therefore, a stable extracorporeal circulation longterm test setting would enable the systematic investigation of the molecular mechanisms and additionally might help replace expensive and complex experimental in vivo animal models.…”

mentioning

confidence: 99%

Twelve Hours In Vitro Biocompatibility Testing of Membrane Oxygenators

Berne

Grottke

Tillmann³

et al. 2015

ASAIO Journal

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In vitro test systems for extracorporeal membrane oxygenation (mock loop) represent an interesting alternative to complex and expensive in vivo test systems to analyze the pathomechanisms leading to insufficient biocompatibility. Data on mock loop systems are limited, and operation times are constricted to a maximum duration of 6 hr. This study aims at a 12 hr operation time and frequent monitoring of markers for insufficient biocompatibility in two experimental settings. Porcine blood circulated in a mock loop without any modifications, or the circuit was operated with a CO2-enhanced gas (5% CO2/21% O2/74% N2) in combination with a nutrient solution (phosphate-adenine-glucose-guanosine-saline-mannitol). Coagulation parameters changed over time without differences between the two groups. In the unmodified test setting, a pH increase was detected after 1 hr, followed by significantly increased levels of free hemoglobin as a marker for hemolysis and elevated numbers of activated platelets, which correlate with detected von Willebrand factor, microparticles, and interleukin-β. Proinflammatory cytokine levels were significantly increased after 12 hr. In contrast, these parameters remained constant in the modified test setting providing proof of a stable operating in vitro mock loop system with an extended/prolonged operation time.

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“…The portable size allows it to be used as ambulatory device. The long term support for 30 days of The APL device had been demonstrated previously (24). The APL device had stable oxygen transfer function and biocompatibility for the 30-day support.…”

Section: Discussionmentioning

confidence: 73%

Right ventricular unloading and respiratory support with a wearable artificial pump-lung in an ovine model

Liu

Sánchez

Wei

et al. 2014

The Journal of Heart and Lung Transplantation

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Background Device availability of mechanical circulatory or respiratory support to the right heart has been limited. The purpose of this study was to investigate the effect of right heart unloading and respiratory support with a wearable integrated artificial pump-lung (APL). Methods The APL device was placed surgically between the right atrium and pulmonary artery in seven sheep. Anticoagulation was performed with heparin infusion. Its ability to unload the right ventricle (RV) was investigated by echocardiograms and right heart catheterization at different bypass flow rates. Hemodynamics and Echo data were evaluated. The device flow and gas transfer rates were also measured at different device speeds. Results Hemodynamics remained stable during APL support. There was no significant change in systemic blood pressure and cardiac index. Central venous pressure, RV pressure, RV end-diastolic dimension and RV ejection fraction were significant decreased when APL device flow rate approached 2 L/min. The linear regression showed significant correlative trends between the hemodynamic and cardiac indices and the device speed. The oxygen transfer rate increased with the device speed. The oxygen saturation from APL outlet was fully saturated (>95%) during the support. The impact of the APL support on blood elements (plasma free hemoglobin and platelet activation) was minimal. Conclusion The APL device support significantly unloaded the right ventricle with increasing device speed. The APL device provided stable hemodynamic and respiratory support in terms of blood flow and oxygen transfer. The right heart unloading performance of this wearable device need to be evaluated in the animal model with right heart failure for a long term support.

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Thirty-Day In-Vivo Performance of a Wearable Artificial Pump-Lung for Ambulatory Respiratory Support

Cited by 34 publications

References 20 publications

Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Long-term support with an ambulatory percutaneous paracorporeal artificial lung

Twelve Hours In Vitro Biocompatibility Testing of Membrane Oxygenators

Right ventricular unloading and respiratory support with a wearable artificial pump-lung in an ovine model

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