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Guenthart BA, O'Neill JD, Kim J, Queen D, Chicotka S, Fung K, Simpson M, Donocoff R, Salna M, Marboe CC, Cunningham K, Halligan SP, Wobma HM, Hozain AE, Romanov A, Vunjak-Novakovic G, Bacchetta M. Regeneration of severely damaged lungs using an interventional cross-circulation platform. Nat Commun 2019; 10:1985. [PMID: 31064987 PMCID: PMC6504972 DOI: 10.1038/s41467-019-09908-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
The number of available donor organs limits lung transplantation, the only lifesaving therapy for the increasing population of patients with end-stage lung disease. A prevalent etiology of injury that renders lungs unacceptable for transplantation is gastric aspiration, a deleterious insult to the pulmonary epithelium. Currently, severely damaged donor lungs cannot be salvaged with existing devices or methods. Here we report the regeneration of severely damaged lungs repaired to meet transplantation criteria by utilizing an interventional cross-circulation platform in a clinically relevant swine model of gastric aspiration injury. Enabled by cross-circulation with a living swine, prolonged extracorporeal support of damaged lungs results in significant improvements in lung function, cellular regeneration, and the development of diagnostic tools for non-invasive organ evaluation and repair. We therefore propose that the use of an interventional cross-circulation platform could enable recovery of otherwise unsalvageable lungs and thus expand the donor organ pool.
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Affiliation(s)
- Brandon A Guenthart
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - John D O'Neill
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Jinho Kim
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ, 07030, USA
| | - Dawn Queen
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Scott Chicotka
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Kenmond Fung
- Department of Clinical Perfusion, Columbia University Medical Center, Columbia University, New York, NY, 1003, USA
| | - Michael Simpson
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Rachel Donocoff
- Institute of Comparative Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Michael Salna
- Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Charles C Marboe
- Department of Pathology and Cell Biology, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Katherine Cunningham
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Susan P Halligan
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Holly M Wobma
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Ahmed E Hozain
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.,Department of Surgery, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Alexander Romanov
- Institute of Comparative Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA
| | - Gordana Vunjak-Novakovic
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA. .,Department of Medicine, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA.
| | - Matthew Bacchetta
- Department of Biomedical Engineering, Columbia University Medical Center, Columbia University, New York, NY, 10032, USA. .,Department of Thoracic and Cardiovascular Surgery, Vanderbilt University, Nashville, TN, 37232, USA.
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Janda M, Scheeren TWL, Nöldge-Schomburg GFE. Management of pulmonary aspiration. Best Pract Res Clin Anaesthesiol 2007; 20:409-27. [PMID: 17080693 DOI: 10.1016/j.bpa.2006.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pulmonary aspiration of gastric contents in the perioperative phase is associated with increased postoperative morbidity and mortality. For the management of aspiration, differentiation between acid-associated aspiration pneumonitis and aspiration pneumonia as a consequence of a secondary bacterial contamination is of crucial importance. The incidence of aspiration in elective surgery is 1 per 2000-3000 anaesthesias in adults. In children, it is slightly more common with 1 per 1200-2600 anaesthesias. In the context of emergency anaesthesias the incidence of aspiration is three to four times higher. The risk particularly increases with recent ingestion of solid food or fluids, with older patients, with pregnant women, and with consciousness-reduced patients. Besides giving a review of the pathophysiology, incidence, and the risk factors of aspiration, this article places emphasis on the practical management of this anaesthesia-associated complication. Cricoid pressure, as a non-evidence-based but clinically wide-spread method in the context of the prophylaxis of aspiration, is discussed critically. The main part deals with strategies to structure the management of aspiration by use of scientific concepts based on medical crisis management. For this, an algorithm based on current scientific investigations is presented.
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Affiliation(s)
- Matthias Janda
- Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Schillingallee 35, 18055 Rostock, Germany.
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