Pediatric Artificial Lung: A Low-Resistance Pumpless Artificial Lung Alleviates an Acute Lamb Model of Increased Right Ventricle Afterload

Abstract

Lung disease in children often results in pulmonary hypertension and right heart failure. The availability of a pediatric artificial lung (PAL) would open new approaches to the management of these conditions by bridging to recovery in acute disease or transplantation in chronic disease. This study investigates the efficacy of a novel PAL in alleviating an animal model of pulmonary hypertension and increased right ventricle afterload. Five juvenile lambs (20-30 Kg) underwent PAL implantation in a pulmonary artery to left atrium configuration. Induction of disease involved temporary, reversible occlusion of the right main pulmonary artery. Hemodynamics, pulmonary vascular input impedance, and right ventricle efficiency were measured under (A) baseline, (B) disease, and (C) disease+PAL conditions. The disease model altered hemodynamics variables in a manner consistent with pulmonary hypertension. Subsequent PAL attachment improved pulmonary artery pressure (p=0.018), cardiac output (p=0.050), pulmonary vascular input impedance (Z.0 p=0.028, Z.1 p=0.058), and right ventricle efficiency (p=0.001). The PAL averaged resistance of 2.3±0.8 mmHg/L/min and blood flow of 1.3±0.6 L/min. This novel low-resistance PAL can alleviate pulmonary hypertension in an acute animal model and demonstrates potential for use as a bridge to lung recovery or transplantation in pediatric patients with significant pulmonary hypertension refractory to medical therapies.

Early in vivo experience with the pediatric continuous-flow total artificial heart

“…Occlusion of the right pulmonary artery (rPA) was used as previously described as a disease model for end stage lung failure. 5 The circuit was completely deaired and primed using approximately 200 mL sterile saline prior to opening arteriovenous flow. Solumedrol was administered (750 mg IV, 250 mg through the device inlet pressure port) immediately prior to opening blood flow to the Pediatric MLung circuit.…”

A Membrane Lung Design Based on Circular Blood Flow Paths

“…The specifications for the initial lung design were intended for testing in our model of end stage lung disease (ESLD) 9 driven by arterial blood pressure without a pump. 10 These specifications are: fiber length 2 cm, device diameter 10 cm, rated flow ≥1 L/min, oxygen transfer at rated flow ≥50 mL/min, pressure drop at 1L/min of 60 mmHg, and CO 2 clearance that is four times oxygen transfer. A membrane lung with these specifications would provide total gas exchange for a 10 kg child and total systemic CO 2 removal for an adult.…”

Artificial Lungs for Lung Failure in the Era of COVID-19 Pandemic: Contemporary Review

“…69 A low-resistance pediatric AL designed using CFD was tested in a pulmonary hypertension model in a juvenile lamb using an in-parallel configuration. 70 The AL improved cardiac output and right ventricular efficiency. Orizondo and colleagues 71 evaluated an AL with an integrated blood pump designed using CFD in a sheep model.…”