New Approaches to Respiratory Assist: Bioengineering an Ambulatory, Miniaturized Bioartificial Lung.

Although state-of-the-art treatments of respiratory failure clearly have made some progress in terms of survival in patients suffering from severe respiratory system disorders, such as acute respiratory distress syndrome (ARDS), they failed to significantly improve the quality of life in patients with acute or chronic lung failure, including severe acute exacerbations of chronic obstructive pulmonary disease or ARDS as well. Limitations of standard treatment modalities, which largely rely on conventional mechanical ventilation, emphasize the urgent, unmet clinical need for developing novel (bio)artificial respiratory assist devices that provide extracorporeal gas exchange with a focus on direct extracorporeal CO2 removal from the blood. In this review, we discuss some of the novel concepts and critical prerequisites for such respiratory lung assist devices that can be used with an adequate safety profile, in the intensive care setting, as well as for long-term domiciliary therapy in patients with chronic ventilatory failure.

In Vivo Testing of Extracorporeal Membrane Ventilators: iLA-Activve Versus Prototype I-Lung.

A side-by-side comparison of the decarboxylation efficacy of two pump-driven venovenous extracorporeal lung assist devices, i.e., a first prototype of the new miniaturized ambulatory extracorporeal membrane ventilator, I-lung versus the commercial system iLA-activve for more than a period of 72 hours in a large animal model.

Pulsatile venoarterial perfusion using a novel synchronized cardiac assist device augments coronary artery blood flow during ventricular fibrillation.

Patients with cardiogenic shock have a very high mortality. Here we report the first use of a percutaneous pulsatile cardiac assist device, based on a diagonal pump synchronized with the heart cycle by means of an electrocardiographic signal in adult pigs. Eight domestic pigs underwent mandatory ventilation.

The influence of controlled limb reperfusion with PGE1 on reperfusion injury after prolonged ischemia.

Background: Controlled reperfusion of ischemic limbs has been found to be protective in limiting ischemia-reperfusion injury. We aimed to analyze local hemodynamic effects of prostaglandin E1 (PGE1) administrated during controlled reperfusion in an in vivo setting.

Material And Methods: Twenty-four pigs underwent exposure of the infrarenal aorta and iliac vessels.

New technologies for respiratory assist.

"The artificial lung especially has lingered behind progress with artificial hearts and ventricular assist devices, not because the need for lungs has not been recognized, but because we have not had a full understanding of the engineering problems and the unique material requirements until recent years." Brack Hattler, MD PhD. The development from the first clinical use of haemodialysis over five decades ago to widespread chronic treatment took more than two decades.

Myocardial rewarming mirrors intraoperative mammary artery graft function.

Background: The internal mammary artery (IMA) bypass graft provides a satisfactorily long-lasting blood supply to the myocardium. However, its initial flow capacity can be insufficient with subsequent regional myocardial ischemia. We evaluated a method to assess the IMA graft function intraoperatively.

Graded reoxygenation limits lipid peroxidation during surgical reperfusion.

Background: Most cardiac operations with cardiopulmonary bypass (CPB) are conducted with high oxygen partial pressure. The hyperoxic reoxygenation of the ischemic heart induced by aortic declamping may be an important component of cardiac reperfusion injury. The present clinical study assessed the preventive effect of graded reoxygenation on lipid peroxidation.

Occupational exposure to inhalational anesthetics during cardiac surgery on cardiopulmonary bypass.

Background: Eventual hazards from occupational exposure of operating room personnel to inhalational anesthetic agents cannot yet be definitively excluded. We determined if occupational exposure of operating room personnel to waste anesthetic gases during cardiopulmonary bypass (CPB) complies with the established governmental limits.

Methods: Ten adults underwent inhalational anesthesia for coronary artery bypass grafting with nitrous oxide and either sevoflurane (n = 5) or desflurane (n = 5).

Cariporide (HOE642) limits S-100B release during cardiac surgery.

Cardiac surgery with cardiopulmonary bypass (CPB) results in transient cerebral swelling in most patients. Cognitive decline occurs in 24-57% of patients and 2-5% experience stroke. Serum levels of S-100B, a potential marker of increased blood-brain barrier permeability, increase during and early after surgery.

Coronary artery bypass grafting through complete sternotomy in conscious patients.

Background: Complete sternotomy is the standard approach in cardiac surgery, and coronary artery bypass grafting (CABG) is the most common revascularization procedure to use this approach. A new technique has been developed that permits complete surgical revascularization with arterial grafts in awake patients. This technique, which we refer to as awake coronary artery bypass grafting, avoids general anesthesia, mechanical ventilation, and extracorporeal circulation, thereby creating the least invasive method for heart operations yet described.