Ambulatory home wearable lung: progress and future directions

Area of Science:

• Cardiothoracic Surgery
• Critical Care Medicine
• Biomedical Engineering

Background:

• Extracorporeal life support (ECLS) originated from cardiopulmonary bypass technology.
• Early applications in acute respiratory distress syndrome (ARDS) faced limitations in technology and disease understanding.
• A resurgence in ECLS use since 2009, driven by the H1N1 pandemic and the CESAR trial, has improved outcomes for severe respiratory failure.

Purpose of the Study:

• To review the historical transition of ventricular assist devices (VADs) towards home use.
• To examine the evolution and current status of ECLS for lung failure.
• To explore emerging ECLS technologies and the potential for home-based ambulatory care.

Main Methods:

• Historical review of ECLS and VAD patient management.
• Analysis of technological advancements in ECLS.
• Discussion of current ECLS applications for long-term lung support.
• Exploration of potential future pathways for home-based ECLS.

Main Results:

• ECLS use has rapidly expanded, particularly for severe respiratory failure.
• Patients on long-term ECLS are increasingly mobile, participating in rehabilitation and ambulation.
• The transition of VAD patients to home care in the 1990s provides a potential model for ECLS.

Conclusions:

• Significant advancements in ECLS technology and patient care are paving the way for home-based support.
• The future may see stable ECLS patients transitioning from hospital to home, mirroring the VAD journey.
• Overcoming current hurdles is essential for realizing ambulatory home wearable lung support.