title: Long-term support with an ambulatory percutaneous paracorporeal artificial lung.
abstract: BACKGROUND
  Conventional extracorporeal membrane oxygenation is bulky and 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. An Avalon Elite dual-lumen cannula (DLC), inserted through the right jugular vein into the superior vena cava, right atrium, and inferior vena cava, was connected to a CentriMag pump and compact hollow-fiber gas exchanger, forming a short-circuit PAL system. All sheep were moved to intensive care unit and were ambulatory after anesthesia recovery. Hemodynamics and device performance were measured daily.
  
  
  RESULTS
  The ambulatory PALs were successfully established in all sheep. The sheep were awake, ate, and moved freely in the metabolic cage, with no need of artificial nutrition or blood transfusion. All sheep had stable hemodynamics, with 2 liters/min of average circuit flow and hemoglobin levels exceeding 9.2 g/dl throughout the experiment. A progressive decrease of oxygen transfer and carbon dioxide removal capacity was observed. Sheep were euthanized between 10 and 24 days for bleeding (n = 2), gas exchanger failure (n = 6), and DLC issues (n = 3).
  
  
  CONCLUSIONS
  We successfully established long-term ambulatory PAL for up to 24 days in 11 animals using our patented DLC through a single-site percutaneous venous cannulation. Critical bleeding/thrombosis formation and gas exchanger durability remain two major challenges for long-term-ambulatory PAL.
authors.affiliation: Department of Surgery, University of Kentucky, College of Medicine, 800 Rose Street, Lexington, KY 40536-0298, USA.
authors.forename: Xiaoqin
authors.initials: X
authors.lastname: Zhou
authors.forename: Dongfang
authors.initials: D
authors.lastname: Wang
authors.forename: Ryan
authors.initials: R
authors.lastname: Sumpter
authors.forename: Gary
authors.initials: G
authors.lastname: Pattison
authors.forename: Cherry
authors.initials: C
authors.lastname: Ballard-Croft
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
mesh_terms: D000818:Animals; D001187:Artificial Organs; D002404:Catheterization; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D007601:Jugular Veins; D008168:Lung; D023421:Models, Animal; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D034561:Sheep, Domestic / Q000502:physiology*