title: Oxygenated shunting from right to left: a feasibility study of minimized atrio-atrial extracorporeal membrane oxygenation for mid-term lung assistance in an acute ovine model.
abstract: OBJECTIVE
  Right ventricular failure is often the final phase in acute and chronic respiratory failure. We combined right ventricular unloading with extracorporeal oxygenation in a new atrio-atrial extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Eleven sheep (65 kg) were cannulated by a 28-Fr inflow cannula to the right atrium and a 25-Fr outflow cannula through the lateral left atrial wall. Both were connected by a serial combination of a microaxial pump (Impella Elect(®), Abiomed Europe, Aachen, Germany) and a membrane oxygenator (Novalung(®)-iLA membrane oxygenator; Novalung GmbH, Hechingen, Germany). In four animals, three subsequent states were evaluated: normal circulation, apneic hypoxia and increased right atrial after load by pulmonary banding. We focused on haemodynamic stability and gas exchange.
  
  
  RESULTS
  All animals reached the end of the study protocol. In the apnoea phase, the decrease in PaO2 (21.4 ± 3.6 mmHg) immediately recovered (179.1 ± 134.8 mmHg) on-device in continuous apnoea. Right heart failure by excessive after load decreased mean arterial pressure (59 ± 29 mmHg) and increased central venous pressure and systolic right ventricular pressure; PaO2 and SvO2 decreased significantly. On assist, mean arterial pressure (103 ± 29 mmHg), central venous pressure and right ventricular pressure normalized. The SvO2 increased to 89 ± 3% and PaO2 stabilized (129 ± 21 mmHg).
  
  
  CONCLUSIONS
  We demonstrated the efficacy of a miniaturized atrio-atrial ECMO. Right ventricular unloading was achieved, and gas exchange was well taken over by the Novalung. This allows an effective short- to mid-term treatment of cardiopulmonary failure, successfully combining right ventricular and respiratory bridging. The parallel bypass of the right ventricle and lung circulation permits full unloading of both systems as well as gradual weaning. Further pathologies (e.g. ischaemic right heart failure and acute lung injury) will have to be evaluated.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany. mhaushofer@ukaachen.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Haushofer
authors.forename: Yousef
authors.initials: Y
authors.lastname: Abusabha
authors.forename: Andrea L A
authors.initials: AL
authors.lastname: Amerini
authors.forename: Jan
authors.initials: J
authors.lastname: Spillner
authors.forename: Christoph
authors.initials: C
authors.lastname: Nix
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Andreas
authors.initials: A
authors.lastname: Goetzenich
authors.forename: Nima
authors.initials: N
authors.lastname: Hatam
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006439:Hemodynamics; D008904:Miniaturization; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange; D012131:Respiratory Insufficiency / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D012756:Sheep; D013997:Time Factors; D018497:Ventricular Dysfunction, Right / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D016278:Ventricular Function, Right
chemical_list: D010100:Oxygen
keywords: Heart-assist devices; Membrane oxygenators; Respiratory insufficiency; Right ventricular dysfunction
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