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

Abstract

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.

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

“…Survival of those most severely affected by COVID-19related ARDS (CARDS) might depend on extracorporeal membrane oxygenation (ECLS) as bridge to recovery. [1][2][3] In this global pandemic, hospitals and healthcare systems have been pushed to the verge of collapse. During the first phase of the COVID-19 pandemic, the number of critically ill patients requiring invasive ventilation often exceeded ventilator capacities, creating a need for intensive care unit (ICU) triage.…”

“…Early in 2020, countries worldwide have been facing a surge of patients with acute respiratory distress syndrome (ARDS) due to pandemic Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) disease 2019 (COVID‐19). Survival of those most severely affected by COVID‐19‐related ARDS (CARDS) might depend on extracorporeal membrane oxygenation (ECLS) as bridge to recovery 1‐3 …”

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.…”

Modern World Applications for Nano-Bio Materials: Tissue Engineering and COVID-19

“…Along with the immunomodulatory effect of stem cells on lung tissue, the complete replacement of injured lung structures for artificial structures that incorporate tissue engineering has also been proposed as an alternative to alleviate the demand for donated organs (Swol et al, 2020). Under this concept, bio-fabricated scaffolds with microfluidic channels enable a high level of biocompatibility and reduced instrumentation sizes, as well as device development flexibility through the adaptation of mechanical components for ventilation.…”