title: The Implantable Pediatric Artificial Lung: Interim Report on the Development of an End-Stage Lung Failure Model.
abstract: An implantable pediatric artificial lung (PAL) may serve as a bridge to lung transplantation for children with end-stage lung failure (ESLF); however, an animal model of pediatric lung failure is needed to evaluate the efficacy of PAL before it can enter clinical trials. The objective of this study was to assess ligation of the right pulmonary artery (rPA) as a model for pediatric ESLF. Seven lambs weighing 20-30 kg underwent rPA ligation and were recovered and monitored for up to 4 days. Intraoperatively, rPA ligation significantly increased physiologic dead space fraction (Vd/Vt; baseline = 48.6 ± 5.7%, rPA ligation = 60.1 ± 5.2%, p = 0.012), mean pulmonary arterial pressure (mPPA; baseline = 17.4 ± 2.2 mm Hg, rPA ligation = 28.5 ± 5.2 mm Hg, p < 0.001), and arterial partial pressure of carbon dioxide (baseline = 40.4 ± 9.3 mm Hg, rPA ligation = 57.3 ± 12.7 mm Hg, p = 0.026). Of the seven lambs, three were unable to be weaned from mechanical ventilation postoperatively, three were successfully weaned but suffered cardiorespiratory failure within 4 days, and one survived all 4 days. All four animals that were successfully weaned from mechanical ventilation had persistent pulmonary hypertension (mPPA = 28.6 ± 2.2 mm Hg) and remained tachypneic (respiratory rate = 63 ± 21 min). Three of the four recovered lambs required supplemental oxygen. We conclude that rPA ligation creates the physiologic derangements commonly seen in pediatric ESLF and may be suitable for testing and implanting a PAL.
authors.affiliation: From the *Department of Surgery, University of Michigan, Extracorporeal Life Support Laboratory, Ann Arbor, Michigan; †Section of General Surgery, Department of Surgery, Columbia University, New York, New York; ‡Section of Transplant Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan; and §Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Fares
authors.initials: F
authors.lastname: Alghanem
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Davis
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Bryner
authors.forename: Hayley R
authors.initials: HR
authors.lastname: Hoffman
authors.forename: John
authors.initials: J
authors.lastname: Trahanas
authors.forename: Marie S
authors.initials: MS
authors.lastname: Cornell
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rojas-Peña
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
mesh_terms: D000818:Animals; D001187:Artificial Organs; D004195:Disease Models, Animal; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000601:surgery; D008026:Ligation; D008168:Lung; D011651:Pulmonary Artery / Q000293:injuries*; D012121:Respiration, Artificial / Q000295:instrumentation; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery; D034561:Sheep, Domestic; D012122:Ventilators, Mechanical