Artificial lungs: a new inspiration

An estimated 16 million Americans are afflicted with some degree of chronic obstructive pulmonary disease (COPD), accounting for 100,000 deaths per year. The only current treatment for chronic irreversible pulmonary failure is lung transplantation. Since the widespread success of single and double lung transplantation in the early 1990s, demand for donor lungs has steadily outgrown the supply. Unlike dialysis, which functions as a bridge to renal transplantation, or a ventricular assist device (VAD), which serves as a bridge to cardiac transplantation, no suitable bridge to lung transplantation exists. The current methods for supporting patients with lung disease, however, are not adequate or efficient enough to act as a bridge to transplantation. Although occasionally successful as a bridge to transplant, ECMO requires multiple transfusions and is complex, labor-intensive, time-limited, costly, non-ambulatory and prone to infection. Intravenacaval devices, such as the intravascular oxygenator (IVOX) and the intravenous membrane oxygenator (IMO), are surface area limited and currently provide inadequate gas exchange to function as a bridge-to-recovery or transplant. A successful artificial lung could realize a substantial clinical impact as a bridge to lung transplantation, a support device immediately post-lung transplant, and as rescue and//or supplement to mechanical ventilation during the treatment of severe respiratory failure.

Download Full-text

Abstract 15226: The Impact of Chronic Obstructive Pulmonary Disease on In-hospital Outcomes Following Left Ventricular Assist Device Implantation

Circulation ◽

10.1161/circ.142.suppl_3.15226 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Bertrand Ebner ◽

Jennifer Maning ◽

Louis Vincent ◽

Jelani Grant ◽

neal olarte ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Left Ventricular Assist Device ◽

Left Ventricular ◽

Chronic Obstructive ◽

Assist Device ◽

Hospital Outcomes ◽

Ventricular Assist ◽

Obstructive Pulmonary Disease ◽

Left Ventricular Assist ◽

The Impact

Background: Chronic obstructive pulmonary disease (COPD) is well-known cause of ventricular dysfunction. However, in the setting of patients with advanced heart failure undergoing left ventricular assist device (LVAD) implantation, there is paucity data on COPD influence on in-hospital outcomes. Methods: This retrospective cohort study based on the Nationwide Inpatient Sample included all patients above 18 years all who underwent LVAD implantation from 2011 to 2017. All data was weight as recommended by Healthcare Cost and Utilization Project.Multivariate logistic regression was used to evaluate the impact of COPD on in-hospital outcomes. Results: A total of 25,503 patients underwent LVAD implantation, of those 13.8% had a pre-existing diagnosis of COPD. Individuals with COPD were older (median 62 vs. 58 years, p<0.001), more commonly male (82% vs. 76.4%, p<0.001). Patient with COPD had a greater burden of comorbidities confirmed by significant higher rate of hypertension, diabetes, atrial tachyarrhythmias, dyslipidemia, prior stroke, coronary and peripheral artery diseases, pulmonary hypertension, and chronic kidney disease (p<0.001 for all). No significant difference was found in in-hospital stroke, infections, short-term percutaneous mechanical circulatory support, implant related complications, and LVAD thrombosis. There was a significant higher rate of inpatient acute kidney injury, major bleeding, cardiac complications, thromboembolism, and cardiac arrest in patients without COPD (p<0.05 for all outcomes). Compared to patients without COPD, individuals with COPD had a lower mortality (6.2% vs. 12.4%; OR 0.59; C.I. 0.512-0.685; p<0.05). Conclusion: Patients with COPD undergoing LVAD implantation have higher comorbidities, however, it is not associated with increase in-hospital all-cause mortality.Further studies are needed to analyze the differences found between these two groups in more detail.

Download Full-text

Impact of Chronic Obstructive Pulmonary Disease on Early Right Ventricular Dysfunction and Failure Following Left Ventricular Assist Device Implantation

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2017.01.982 ◽

2017 ◽

Vol 36 (4) ◽

pp. S350

Author(s):

R.M. Hasson Charles ◽

S.D. Moffatt-Bruce ◽

E. Cerier ◽

S.A. Smith ◽

B.C. Lampert ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

Left Ventricular ◽

Chronic Obstructive ◽

Assist Device ◽

Ventricular Assist ◽

Obstructive Pulmonary Disease ◽

Device Implantation ◽

Left Ventricular Assist

Download Full-text

Evaluating the impact of chronic obstructive pulmonary disease on in‐hospital outcomes following left ventricular assist device implantation

Journal of Cardiac Surgery ◽

10.1111/jocs.15084 ◽

2020 ◽

Vol 35 (12) ◽

pp. 3374-3380

Author(s):

Bertrand Ebner ◽

Jelani K. Grant ◽

Louis Vincent ◽

Jennifer Maning ◽

Neal Olarte ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Left Ventricular Assist Device ◽

Left Ventricular ◽

Chronic Obstructive ◽

Assist Device ◽

Ventricular Assist ◽

Obstructive Pulmonary Disease ◽

Device Implantation ◽

Left Ventricular Assist ◽

The Impact

Download Full-text

INTERVENTIONAL PULMONARY ASSISTANCE (iLA) AS A BRIDGE TO LUNG TRANSPLANTATION

British Journal of Surgery ◽

10.1093/bjs/znab160.002 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

N Burgos Frías ◽

M Córdoba Peláez ◽

A Sánchez Calle ◽

J L Campo Cañaveral ◽

D Martínez López ◽

...

Keyword(s):

Mechanical Ventilation ◽

Lung Transplantation ◽

Lung Transplant ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Mechanically Ventilated ◽

Number Of Patients ◽

Interventional Lung Assist ◽

Respiratory Assistance ◽

Mean Time

Abstract INTRODUCTION According to the “International Society for Heart and Lung Transplantation” (ISHLT), between 1 and 4% of patients awaiting a lung transplant will need some type of respiratory assistance as a bridge to transplantation. The objective of this study is to analyze the results of patients assisted with the iLA “Interventional Lung Assist” system (Novalung®). MATERIAL AND METHODS The iLA respiratory assistance system (Novalung®) has been used in 12 patients as a bridge to lung transplantation (three chronic obstructive pulmonary disease, five obliterative bronchiolitis, two pulmonary fibrosis, one chest trauma, one pulmonary leiomyomatosis). The gasometric parameters that indicated the assistance were: PaO2: 76.1 ± 29; PaCO2: 110.6 ± 49; pH: 7.12 ± 0.1. The patients were anticoagulated with intravenous sodium heparin (aPTT 160-180 seconds). RESULTS Six hours after the start of respiratory assistance, the gasometric parameters were: PaO2: 89 ± 17 (p > 0.05); PaCO2: 54.6 ± 5 (p < 0.05); pH 7.34 ± 0.1 (p < 0.05). The mean time of attendance was 16.8 ± 8 (4-28) days. Of the total number of patients attended: one died during the care and the remaining 11 were transplanted, of which 8 survived the lung transplant. CONCLUSIONS Respiratory assistance using iLA (Novalung®) has proven to be an effective method as a bridge to lung transplantation. It allows to improve lung function and avoid mechanical ventilation. It is indicated in patients with nonpermissive hypercapnia to avoid mechanical ventilation. In mechanically ventilated patients, iLA assistance improves ventilator tidal volume, FiO2 and PEEP.

Download Full-text

Smoking Mechanics and Impact on Smoking Cessation: Two Cases of Smoking Lapse Status Post Lung Transplantation

Tobacco Use Insights ◽

10.1177/1179173x211069634 ◽

2022 ◽

Vol 15 ◽

pp. 1179173X2110696

Author(s):

Panagis Galiatsatos ◽

Princess Ekpo ◽

Raiza Schreiber ◽

Lindsay Barker ◽

Pali Shah

Keyword(s):

Lung Transplantation ◽

Lung Transplant ◽

Transplant Patient ◽

Smoking Behavior ◽

Lung Mechanics ◽

Chronic Obstructive ◽

Behavior Changes ◽

Post Transplantation ◽

Obstructive Pulmonary Disease ◽

Tobacco Usage

Background Smoking behavior includes mechanisms taken on by persons to adjust for certain characteristic changes of cigarettes. However, as lung function declines due to lung-specific diseases, it is unclear how mechanical smoking behavior changes affect persons who smoke. We review two cases of patients who stopped smoking prior to and then subsequently resumed smoking after lung transplantation. Methods A retrospective review of two patients who were recipients of lung transplantation and sustained from cigarette usage prior to transplantation. Results Patient A was a 54-year-old woman who received a double lung transplant secondary to chronic obstructive pulmonary disease (COPD) in October 2017. She had stopped smoking cigarettes in July 2015 (FEV1 .56 L). Patient B was a 40-year-old man who received a double lung transplantation due to sarcoidosis in January 2015. He stopped smoking cigarettes in February 2012 (FEV1 1.15 L). Post-transplant, Patient A resumed smoking on March 2018 where her FEV1 was at 2.12 L (5 months post-transplantation), and Patient B resumed smoking in April 2017 where his FEV1 was 2.37 L (26 months post-transplantation). Conclusion We report on two patients who resumed smoking after lung transplantation. While variations of smoking mechanics have been identified as a function of nicotine yield and type of cigarette, it lung mechanics may play a role in active smoking as well. Therefore, proper screening for tobacco usage post-lung transplantation should be considered a priority in order to preserve transplanted lungs.

Download Full-text

Retrospective evaluation of emergency department admissions in patients with ventricular assist device

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907919833536 ◽

2019 ◽

pp. 102490791983353

Author(s):

Ilhan Uz ◽

Enver Özçete ◽

Pelin Öztürk

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Ventricular Assist Device ◽

International Normalized Ratio ◽

Emergency Department Visits ◽

Ventricular Assist Devices ◽

Chronic Obstructive ◽

Assist Device ◽

Ventricular Assist ◽

Obstructive Pulmonary Disease

Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 ± 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and device-related complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for device-related problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems.

Download Full-text