title: Pediatric Artificial Lung: A Low-Resistance Pumpless Artificial Lung Alleviates an Acute Lamb Model of Increased Right Ventricle Afterload.
abstract: Lung disease in children often results in pulmonary hypertension and right heart failure. The availability of a pediatric artificial lung (PAL) would open new approaches to the management of these conditions by bridging to recovery in acute disease or transplantation in chronic disease. This study investigates the efficacy of a novel PAL in alleviating an animal model of pulmonary hypertension and increased right ventricle afterload. Five juvenile lambs (20-30 kg) underwent PAL implantation in a pulmonary artery to left atrium configuration. Induction of disease involved temporary, reversible occlusion of the right main pulmonary artery. Hemodynamics, pulmonary vascular input impedance, and right ventricle efficiency were measured under 1) baseline, 2) disease, and 3) disease + PAL conditions. The disease model altered hemodynamics variables in a manner consistent with pulmonary hypertension. Subsequent PAL attachment improved pulmonary artery pressure (p = 0.018), cardiac output (p = 0.050), pulmonary vascular input impedance (Z.0 p = 0.028; Z.1 p = 0.058), and right ventricle efficiency (p = 0.001). The PAL averaged resistance of 2.3 ± 0.8 mm Hg/L/min and blood flow of 1.3 ± 0.6 L/min. This novel low-resistance PAL can alleviate pulmonary hypertension in an acute animal model and demonstrates potential for use as a bridge to lung recovery or transplantation in pediatric patients with significant pulmonary hypertension refractory to medical therapies.
authors.affiliation: From the *Extracorporeal Life Support Laboratory, University of Michigan, Ann Arbor, Michigan; †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: Benjamin S
authors.initials: BS
authors.lastname: Bryner
authors.forename: Emilia M
authors.initials: EM
authors.lastname: Jahangir
authors.forename: Uditha P
authors.initials: UP
authors.lastname: Fernando
authors.forename: John M
authors.initials: JM
authors.lastname: Trahanas
authors.forename: Hayley R
authors.initials: HR
authors.lastname: Hoffman
authors.forename: Robert H
authors.initials: RH
authors.lastname: Bartlett
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rojas-Peña
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
mesh_terms: D000818:Animals; D001187:Artificial Organs; D002648:Child; D004195:Disease Models, Animal; D006352:Heart Ventricles / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology / Q000628:therapy*; D008168:Lung / Q000503:physiopathology; D008297:Male; D011651:Pulmonary Artery; D012756:Sheep