A Pumpless Pediatric Artificial Lung Maintains Function for 72 h Without Systemic Anticoagulation Using the Nitric...

Area of Science:

• Biomedical Engineering
• Cardiopulmonary Support
• Pediatric Critical Care

Background:

• Children with end-stage lung disease often require extracorporeal life support (ECLS) as a bridge to lung transplantation.
• Pumpless artificial lungs (MLung) offer a portable alternative to ECLS, enabling patient ambulation.
• Current ECLS and MLung systems necessitate systemic anticoagulation, increasing risks of hemorrhagic complications.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel Nitric Oxide (NO) Surface Anticoagulation (NOSA) system integrated with a pumpless artificial lung (MLung).
• To assess the MLung's gas exchange capabilities and the NOSA system's ability to provide local anticoagulation for 72 hours in a pediatric ovine model.

Main Methods:

• Four pediatric-size sheep underwent thoracotomy and cannulation for MLung connection.
• The MLung circuit and connectors were coated with a Nitric Oxide (NO) donor and argatroban (NOSA system).
• Animals were monitored for 72 hours with NO added to the sweep gas; systemic hemodynamics, blood chemistry, and gases were analyzed.

Main Results:

• The MLung demonstrated effective gas exchange with mean device flow of 836 mL/min and outlet saturation of 97%.
• The NOSA system maintained local anticoagulation, with activated clotting time averaging 170s and minimal methemoglobin increase (2.9%).
• Platelet counts declined, but the system functioned effectively for 72 hours without significant hemodynamic changes.

Conclusions:

• The pumpless artificial lung (MLung) provides effective gas exchange for 72 hours in a pediatric ovine model.
• The Nitric Oxide (NO) Surface Anticoagulation (NOSA) system successfully achieved local anticoagulation without systemic adverse effects.
• This integrated system represents a promising, portable, and potentially safer alternative to traditional extracorporeal life support for pediatric patients.