title: Use of a low-resistance compliant thoracic artificial lung in the pulmonary artery to pulmonary artery configuration.
abstract: BACKGROUND
  Thoracic artificial lungs have been proposed as a bridge to transplant in patients with end-stage lung disease. Systemic embolic complications can occur after thoracic artificial lung attachment in the pulmonary artery to left atrium configuration. Therefore, we evaluated the function of a compliant thoracic artificial lung attached via the proximal pulmonary artery to distal main pulmonary artery configuration.
  
  
  METHODS
  The compliant thoracic artificial lung was attached to 5 sheep (63 ± 0.9 kg) in the proximal pulmonary artery to distal main pulmonary artery configuration. Device function and animal hemodynamics were assessed at baseline and with approximately 60%, 75%, and 90% of cardiac output diverted to the compliant thoracic artificial lung. At each condition, dobutamine (0 and 5 μg·kg(-1)·min(-1)) was used to simulate rest and exercise conditions.
  
  
  RESULTS
  At rest, cardiac output decreased from 6.20 ± 0.53 L/min at baseline to 5.40 ± 0.43, 4.66 ± 0.31, and 4.05 ± 0.27 L/min with 60%, 75%, and 90% of cardiac output to the compliant thoracic artificial lung, respectively (P < .01 for each flow diversion vs baseline). During exercise, cardiac output decreased from 7.85 ± 0.70 L/min at baseline to 7.46 ± 0.55, 6.93 ± 0.51, and 5.96 ± 0.44 L/min (P = .82, P = .19, and P < .01 with respect to baseline) with 60%, 75%, and 90% of cardiac output to the compliant thoracic artificial lung, respectively. The artificial lung resistance averaged 0.46 ± 0.02 and did not vary significantly with blood flow rate.
  
  
  CONCLUSIONS
  Use of a compliant thoracic artificial lung may be feasible in the proximal pulmonary artery to distal main pulmonary artery setting if its blood flow is held at less than 75% of cardiac output. To ensure a decrease in cardiac output of less than 10%, a blood flow rate less than 60% of cardiac output is advised.
authors: Department of General Surgery, University of Michigan Medical Center, Ann Arbor, Mich, USA.
authors: Christopher N
authors: CN
authors: Scipione
authors: Rebecca E
authors: RE
authors: Schewe
authors: Kelly L
authors: KL
authors: Koch
authors: Andrew W
authors: AW
authors: Shaffer
authors: Amit
authors: A
authors: Iyengar
authors: Keith E
authors: KE
authors: Cook
mesh_terms: D000818:Animals; D062186:Arterial Pressure / Q000502:physiology; D001187:Artificial Organs; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics / Q000502:physiology; D008168:Lung / Q000502:physiology*; D008170:Lung Compliance; D016040:Lung Transplantation; D008297:Male; D010805:Physical Conditioning, Animal; D011651:Pulmonary Artery / Q000502:physiology*; D012146:Rest; D012756:Sheep; D013908:Thoracotomy; D014655:Vascular Resistance
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