title: Automatic Control of Veno-Venous Extracorporeal Lung Assist.
abstract: Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value <35 mm Hg or >49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P < 0.05). The "SmartECLA" demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit.
authors: Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany. rkopp@ukaachen.de.
authors: Ruedger
authors: R
authors: Kopp
authors: Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
authors: Ralf
authors: R
authors: Bensberg
authors: Informatik 11-Embedded Software, RWTH Aachen University, Aachen, Germany.
authors: Andre
authors: A
authors: Stollenwerk
authors: Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
authors: Jutta
authors: J
authors: Arens
authors: Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors: Oliver
authors: O
authors: Grottke
authors: Philips Chair for Medical Information Technology, RWTH Aachen University, Aachen, Germany.
authors: Marian
authors: M
authors: Walter
authors: Department of Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.|Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen, Germany.
authors: Rolf
authors: R
authors: Rossaint
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000097:blood; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000503:physiopathology; D010313:Partial Pressure; D011659:Pulmonary Gas Exchange; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013552:Swine
chemical_list: D002245:Carbon Dioxide
keywords: Adult; Animal model; Automation; Biological; Extracorporeal membrane oxygenation; Models; Respiratory distress syndrome