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Feasibility of a pumpless extracorporeal respiratory assist device.

BACKGROUND: Our study evaluated the efficacy and feasibility of a pumpless respiratory assist device and determined its capacity for carbon dioxide removal. METHODS: In five adult pigs the left femoral vein and artery were cannulated with a 20F cannula and connected to a low-pressure hollow-fiber artificial lung. After we had obtained baseline values of mean arterial pressure, cardiac output, and blood flow across the artificial lung, the mean arterial pressure was reduced 20% and 40% relative to baseline; in a second phase, it was raised 20% and 40. Cardiac output and artificial lung flow were simultaneously recorded. We determined the carbon dioxide removal capacity of the artificial lung by gradually increasing the arterial partial carbon dioxide tension of the animal. RESULTS: An increase of 10 mm Hg in mean arterial pressure resulted in an increase of flow of 0.14 L/min. The mean pressure drop across the artificial lung was measured at 17 +/- 9 mm Hg. The shunt flow over the artificial lung varied between 14 and 25% of the cardiac output of the animal. Depending on inlet conditions, carbon dioxide removal by the artificial lung was between 62 +/- 22 mL/L/min and 104 +/- 25 mL/L/min. CONCLUSIONS: A pumpless respiratory assist device can remove a significant proportion of the metabolic carbon dioxide production. However, adequate mean arterial pressure is mandatory to maintain sufficient flow across the device. The technique seems attractive because of its simplicity and can be used in acute lung injury in conjunction of apneic oxygenation for prolonged respiratory support.

Airway Resistance↗

Defining ASAIO.

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Animals↗

A model enzymic extracorporeal detoxification system.

Preliminary studies at the University of Oklahoma have incorporated the use of a continuous, seal-less blood centrifuge as an extracorporeal detoxification unit to aid in the removal of foreign chemicals from the blood. Detoxification is performed by immobilized enzymes in conjunction with a cofactor (NADPH) bound to a water-soluble macromolecule. A drug enters the device with the plasma and then passes across a semipermeable membrane which serves to retain the cofactor. At this point, a combination of the drug, the cofactor and the enzyme react to form the drug-oxide. The oxide then passes back through the membrane into the blood and back into the body. Concurrently, the macro-NADP+ is reduced by G-6-P and G-6-PD in the cofactor regeneration portion of the device. To facilitate detoxification, the centrifuge is employed to provide plasma rich in toxins, but void of potentially interfering blood components such as platelets and whole blood cells. These components tend to dilute the toxins or adhere to the interfacing membrane, decreasing the permeability of these toxins into the detoxification unit. It is felt that the centrifuge-detoxification combination will provide a potentially efficient hepatic assist device.

Aniline Compounds↗

A new multilayered composite hollow fiber membrane for artificial lung.

The gas transfer performances in a gas/membrane/liquid system were investigated in detail with various membranes. It was found that the oxygen flux in the gas/membrane/liquid system was saturated when the oxygen flux (Fg-g) in the gas/membrane/gas system became more than 1.0 x 10(-5) cm3 (STP) cm-2s-1cm Hg-1 (Fcg-g). This was explained as follows: The resistance of a boundary layer at liquid phase is dominant, i.e., the membrane resistance is negligible in the region of Fg-g which is greater than Fcg-g. Consequently, Fg-g of the membrane should be designed to be greater than Fcg-g, in order to satisfy the gas transfer performance required for blood oxygenation. On the basis of the results above, we have developed a new three-layered composite hollow fiber membrane (MHF) consisting of an ultrathin polyurethane layer supported between two microporous polyethylene layers to prevent serum leakage. It was shown through the evaluation in vitro that MHF had good gas transfer performances for long-term perfusion, and no serum leakage was observed. These characteristics suggest that MHF is quite suitable for long-term usage such as extracorporeal membrane oxygenation (ECMO).

Artificial Organs↗

New technologies for organ replacement and augmentation.

The most common causes of disability and death are diseases of the heart, lungs, liver, kidneys, and pancreas, many of which are potentially treated by organ transplantation. The effect of organ dysfunction and failure will likely grow over time, and patients will increasingly expect "safer" transplants, in particular in cases of "preemptive transplantation." New technologies are being developed in part because of the limited availability of organs, and include transplantation with stem cells, tissue engineering, cloning, and xenotransplantation, which some researchers believe promise ready solutions. Although exciting, none of these approaches alone is likely to address the need for organ replacement. We propose that a melding of these new technologies adapted to the distinct challenges and imperatives of the various organs may address this daunting challenge.

Animals↗

EC CO2R: oxygenator or hemodialyzer? An in vitro study.

In respiratory support of patients with acute respiratory distress syndrome (ARDS), the extracorporeal CO2 removal (EC CO2R) technique should be the earliest and easiest procedure so as to have the lowest blood flow rate. Extracorporeal circulation (ECC) can be achieved using an oxygenator for CO2 removal under the dry form (dissolved CO2) or a hemodialyser for CO2 removal under the wet form (bicarbonates). This study investigated different methods allowing an increase in CO2 transfer, using liquid flow rates up to 0.330 l/min. The experimental set-up employed heated (38 degrees C) aqueous polyelectrolytic solutions mimicking the venous blood (pH 7.20, PCO2 53 mmHg). Four in vitro methods were tested: Series I: a DIDECO D702 oxygenator without blood (= liquid) acidification, Series II: D702 oxygenator with inlet HCl acidification, Series III: a HOSPAL H10-10 hemodialyzer without dialysate alkalinisation, Series IV: H10-10 hemodialyzer with NaOH dialysate alkalinisation. Maximum gas flow in the oxygenator and dialysate rate in hemodialyzer were 5 and 0.55 l/min respectively. For the four series the CO2 transfer (TCO2) (mean +/- S.E. ml/min) and pH out were: [table: see text] The difference between the four series was statistically significant (t-test). Acidification using the oxygenator increased CO2 transfer by 80%, but CO2 elimination was better with hemodialysis.

Artificial Organs↗