Development of a Paracorporeal Pump-Integrated Artificial Lung for Transport of Warfighters with Acute Respiratory Distress Syndrome (ARDS)
Abstract
In this proposal, we are targeting the Topic Area of Acute Lung Injury with an Area of Encouragement regarding the development of “strategies to stabilize and support the safe transport of patients with ALI/ARDS.” Acute lung injury (ALI) significantly contributes to combat casualty. Acute respiratory distress syndrome (ARDS) is a serious form of ALI with high mortality, requiring comprehensive treatment in a regional medical center. Long distance air transportation of ARDS Warfighters is a tremendous challenge with the potential for dangerously low oxygen levels and high carbon dioxide levels in these patients. Mechanical ventilation with sedation is currently used for this air transport. Mechanical ventilation, however, does not address carbon dioxide removal and oxygen exchange inside the lungs. Mechanical ventilation management during air transport is also complicated due to the depth of sedation, synchronization to patient breathing, and patient’s extent of airway opening. A lung support system that can perform the gas exchange function of lungs (CO2 removal and oxygen exchange) is highly desired for safe long distance air transport of ARDS Warfighters. Two lung support systems were used in Operation Iraqi Freedom and Operation Enduring Freedom to transport ARDS Warfighters. However, both lung support systems had major problems, which prevented their widespread use. The interventional lung assist (iLA) system supplied only partial lung support (CO2 removal but negligible oxygenation) and required a dangerous major artery cannulation. The venovenous extracorporeal membrane oxygenation (vv ECMO) system was bulky and complicated, requiring remote positioning from the ARDS Warfighter with very long connection tubing. For military transport of ARDS Warfighters, this long connection tubing was especially dangerous due to: (1) the risk of tubing disconnection with massive bleeding, (2) the potential for tubing kinking with lung support circuit dysfunction, (3) the high circuit blood resistance with compromised lung support performance, and (4) the large foreign surface area with increased biocompatibility issues. Thus, there is a critical need for a simpler lung support system without the dangerously long blood tubing connection for more practical, easier, and safer transport of ARDS Warfighters. Our ultimate goal is to develop a simple lung support system with no need of long blood tubing connection for the safe Warfighter transfer from combat theaters to regional medical centers. The enabling technology is our patented paracorporeal pump-integrated artificial lung (pPIAL). Our objective is to design one device (pPIAL) to replace separate artificial lung (gas exchange device) and bulky pump. This one-piece, compact pPIAL allows direct attachment to patient body, eliminating the long tubing connection. Specific Aim 1: To develop and fabricate a pPIAL working prototype with pneumatic console. The one-piece pPIAL will consist of an artificial lung and an integrated pump. The artificial lung will be compact size with an even blood flow pattern. A small cylinder-shaped blood pump will be embedded within the artificial lung. A pneumatic console that is electronically controlled via a 12v DC power supply will also be developed. This console drives the pump to withdraw blood from the patient and deliver oxygenated blood back to the patient. The console will also be designed to control sweep gas flow to facilitate ambulation. The compact pPIAL will be wearable with the console remotely positioned and connected to the pPIAL by only a pneumatic, non-blood containing line. Computational fluid dynamics will be used to optimize the design for maximum performance. Specific Aim 2: To evaluate the pPIAL in vitro gas exchange efficiency and pump performance. The pPIAL prototype will be bench tested in a mock circuit for its pump and gas exchange performance. Long-term pPIAL endurance will also be assessed
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910533
Entities
People
- Dongfang Wang
Organizations
- United States Army
- University of Kentucky