ECMO to Go: The “Hannover Artificial Lung - HArt-Lung” Concept

Background: Recent development of mechanical-circulatory-support devices (MCS) have substantially contributed to increased survival amongst heart and lung failure patients. While results in terminal heart failure treatment have continuously improved, results for MCS in terminal lung failure remain poor, especially because hypoxemic respiratory failure is often associated with consecutive hemodynamic impairment based on right heart failure demanding further mechanical support.

Methods: As unique challenges regarding prolonged support such as mobilization and physical activity need to be addressed, we present our concept of a novel mobile active lung- support-system—the “Hannover-Artificial-Lung—HArt-Lung”. For treatment of right heart impairment following lung failure. We developed a novel concept from bench to bedside using a combination of percutaneous dual-lumen right atrium to pulmonary artery cannula with a paracorporeal pulsatile MCS, augmented by an oxygenator.

The novel HArt-Lung concept was initially tested in an in-vitro-mock-circulation. After assurance of safety and feasibility of the in-vitro analyses, the transfer into initial clinical use to treat combined right heart and lung failure was performed in a patient with severe heart/lung failure following complex cardiac surgery.

Results: In-vitro mock-loop-testing proved reliable and fully supported physiological pressure circumstances which were reproduceable in vivo. Full support of up to 3.8 liters of pulsatile flow/minute with human-like gas exchange capacity and physiological pressures within the pulmonary flow path was achieved with the system. The overall setup was successfully clinically evaluated in a patient as a clinical proof of concept.

Conclusion: We report on the successful bench-to-bedside implementation of a novel concept for percutaneous treatment of combined right heart and lung failure, called “HArt-Lung–concept”. The concept was proven feasible and provides a mobile, pulsatile and miniaturized option for the treatment of lung failure.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024