Development and Clinical Use of an Artificial Lung

Current Surgery Reports, Sep 2014

In the 1970s, the use of cardiopulmonary bypass at the bedside for critically ill patients with respiratory failure began and was termed extracorporeal membrane oxygenation (ECMO). Later, in the 1980s, applications for extracorporeal technology expanded, and included oxygenation, CO2 removal, and hemodynamic support. However, early studies regarding the use of ECMO for acute lung failure provided less than optimistic results. Today, recent research has created a renewed interest in such technology. There have been progressive advancements in artificial lung technology, and ECMO serves as a form of life support and as a bridge to transplantation for critically ill patients when traditional supportive care is no longer effective. These progressive advancements in artificial lung technology provide another tool in the critical care physician’s arsenal to combat this often fatal injury.

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Development and Clinical Use of an Artificial Lung

Nathan L. Kister 0 1 Brittany A. Zwischenberger 0 1 Jeremiah T. Martin 0 1 Joseph B. Zwischenberger 0 1 0 N. L. Kister B. A. Zwischenberger J. T. Martin J. B. Zwischenberger (&) Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky , 800 Rose Street, MN260 , Lexington, KY 40536-0298, USA 1 This article is part of the Topical Collection on Artificial Organ CT Surgery In the 1970s, the use of cardiopulmonary bypass at the bedside for critically ill patients with respiratory failure began and was termed extracorporeal membrane oxygenation (ECMO). Later, in the 1980s, applications for extracorporeal technology expanded, and included oxygenation, CO2 removal, and hemodynamic support. However, early studies regarding the use of ECMO for acute lung failure provided less than optimistic results. Today, recent research has created a renewed interest in such technology. There have been progressive advancements in artificial lung technology, and ECMO serves as a form of life support and as a bridge to transplantation for critically ill patients when traditional supportive care is no longer effective. These progressive advancements in artificial lung technology provide another tool in the critical care physician's arsenal to combat this often fatal injury. - Despite the continued evolution and advancements in critical care medicine, acute respiratory failure continues to cause significant morbidity and mortality worldwide. Vasilyev et al. [1] found in an intercontinental trial that the in-hospital mortality rates for acute lung injury approached 45 %. While positive pressure ventilation has been the cornerstone of managing patients with significant lung injury, there have been progressive advancements in artificial lung technology which may provide another tool in the critical care physicians arsenal to combat this often fatal injury. Early studies regarding the use of extracorporeal membrane oxygenation (ECMO) for acute lung failure provided less than optimistic results [2]. Recent research, however, has created a renewed interest in such technology. Studies such as the CESAR trial and recent experience with H1N1 pandemics have shown the potential benefit and possible superiority of ECMO to traditional ventilator support [3, 4]. This article aims to review the development, current use, and potential future direction of artificial lung technology in the adult patient with lung failure. The term artificial lung has for the most part been used to refer to venovenous ECMO (VV-ECMO) although some other support devices which function to assist or replace the oxygenation and ventilation functions of the lung may be grouped under this terminology [5]. ECMO is a broad term that encompasses many different variations of extracorporeal oxygenation. The two main types of ECMO are venoarterial (VA) and venovenous (VV). VA-ECMO is most commonly used for patients with both heart and lung failure and functions more as the traditional cardiopulmonary bypass machine in which oxygenated and pressurized blood is returned to the systemic circulation. VV-ECMO more appropriately functions as an artificial lung as it replaces the respiratory component of the lung but does not replace the patients intrinsic cardiac function. Hence the discussion of this article will focus on the clinical aspects of VV-ECMO rather than the complete cardiopulmonary support of VA-ECMO. The need for artificial lung technology to replace the respiratory functions of the lungs (oxygenation and ventilation) is usually secondary to acute lung injury which may be induced by any variety of pulmonary insults, including surgery, trauma, or infection. Only patients whose lung function is expected to make a recovery should be considered candidates for VV-ECMO. Recent advances in technology which allow for patients to be maintained on ECMO for longer periods of time are now questioning whether the artificial lung can be used as a bridge to transplant in patients with end-stage lung disease until donor organs become available [6]. In patients with acute lung injury, mortality can range anywhere from 34 to 58 % [3]. The vast majority of patients with acute respiratory failure are managed with positive pressure ventilation. Ventilators alone or in combination with other rescue strategies are often able to provide support in the form of oxygenation and ventilation but only if the lung parenchyma itself is not too severely damaged to perform these basic functions. Unfortunately, positive pressure ventilation comes with risks including pneumonia, need for sedation and immobility, and further damage to the lung parenchyma itself through barotrauma, which can escalate the injury to an already compromised lung tissue. VV-ECMO has shown promise in replacing the respiratory function of the lung, while at the same time allowing the native lung tissue to heal without the harsh and unnatural positive pressure ventilation. For patients who have reached e (...truncated)


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Nathan L. Kister, Brittany A. Zwischenberger, Jeremiah T. Martin, Joseph B. Zwischenberger. Development and Clinical Use of an Artificial Lung, Current Surgery Reports, 2014, pp. 68, Volume 2, Issue 10, DOI: 10.1007/s40137-014-0068-8