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The hollow fiber membrane bundle is the functional component of artificial lungs, transferring oxygen to and carbon dioxide from the blood. It is also the primary location of blood clot formation and propagation in these devices. The geometric design of fiber bundles is defined by a narrow set of parameters that determine gas exchange efficiency and blood flow resistance, principally: fiber packing density, path length, and frontal area. These same parameters also affect thrombosis. This study investigated the effect of these parameters on clot formation using 3D printed flow chambers that mimic the geometry and blood flow patterns of fiber bundles. Hollow fibers were represented by an array of vertical micro‐rods (380 μm diameter) arranged with three packing densities (40%, 50%, and 60%) and two path lengths (2 and 4 cm). Blood was pumped through these devices corresponding to three mean blood flow velocities (16, 20, and 25 cm/min). Results showed that (1) clot formation decreases dramatically with decreasing packing density and increasing blood flow velocity, (2) clot formation at the outlet of the fiber bundle enhances deposition upstream, and consequently (3) greater path length provides greater clot‐free fiber surface area for gas exchange than a shorter path length. These results can help guide the design of less thrombogenic, more efficient artificial lung designs. [ABSTRACT FROM AUTHOR]

Blood oxygenators are used to saturate oxygen levels and remove carbon dioxide from the body during cardiopulmonary bypass. Although the natural lung is hydrophilic, commercially used oxygenator materials are hydrophobic. Surface hydrophobicity weakens blood compatibility, as long‐term contact with the blood environment may lead to different degrees of blood activity. Polysulfone may be considered an alternative hydrophilic material in the design of oxygenators. Therefore, it may be directed toward developing hydrophilic membranes. This study aims to investigate the feasibility of achieving blood gas transfer with a polysulfone‐based microporous hollow fiber membrane and compare it with the commercially available polypropylene membranes. Structural differences in the membrane morphology, surface hydrophilicity, tortuosity, mass transfer rate, and material properties under different operation conditions of temperature and flow rates are reported. The polysulfone membrane has a water contact angle of 81.3°, whereas a commercial polypropylene membrane is 94.5°. The mass transfer resistances (s/m) for the polysulfone and polypropylene membranes are calculated to be 4.8 × 104 and 1.5 × 104 at 25°C, respectively. The module made of polysulfone was placed in the cardiopulmonary bypass circuit in parallel with the commercial oxygenator, and pH, pO2, pCO2 levels, and metabolic activity were measured in blood samples. [ABSTRACT FROM AUTHOR]

The increasing prevalence of chronic lung disease worldwide, combined with the emergence of multiple pandemics arising from respiratory viruses over the past century, highlights the need for safer and efficacious means for providing artificial lung support. Mechanical ventilation is currently used for the vast majority of patients suffering from acute and chronic lung failure, but risks further injury or infection to the patient's already compromised lung function. Extracorporeal membrane oxygenation (ECMO) has emerged as a means of providing direct gas exchange with the blood, but limited access to the technology and the complexity of the blood circuit have prevented the broader expansion of its use. A promising avenue toward simplifying and minimizing complications arising from the blood circuit, microfluidics‐based artificial organ support, has emerged over the past decade as an opportunity to overcome many of the fundamental limitations of the current standard for ECMO cartridges, hollow fiber membrane oxygenators. The power of microfluidics technology for this application stems from its ability to recapitulate key aspects of physiological microcirculation, including the small dimensions of blood vessel structures and gas transfer membranes. An even greater advantage of microfluidics, the ability to configure blood flow patterns that mimic the smooth, branching nature of vascular networks, holds the potential to reduce the incidence of clotting and bleeding and to minimize reliance on anticoagulants. Here, we summarize recent progress and address future directions and goals for this potentially transformative approach to artificial lung support. Correspondence between native blood vessel branching and the microfluidic blood vessel branching patterns that form the design basis for bio‐inspired artificial organs. As in the physiological vasculature, a large inlet vessel branches into multiple trunk lines, each of which leads to further branching into smaller microchannels. This design paradigm preserves a smooth distribution of blood flow throughout the microfluidic network. [ABSTRACT FROM AUTHOR]

Background: Membranes based on triply periodic minimal surfaces (TPMS) have proven a superior gas transfer compared to the contemporary hollow fiber membrane (HFM) design in artificial lungs. The improved oxygen transfer is attributed to disrupting the laminar boundary layer adjacent to the membrane surface known as main limiting factor to mass transport. However, it requires experimental proof that this improvement is not at the expense of greater damage to the blood. Hence, the aim of this work is a valid statement regarding the structure‐dependent hemolytic behavior of TPMS structures compared to the current HFM design. Methods: Hemolysis tests were performed on structure samples of three different kind of TPMS‐based designs (Schwarz‐P, Schwarz‐D and Schoen's Gyroid) in direct comparison to a hollow fiber structure as reference. Results: The results of this study suggest that the difference in hemolysis between TPMS membranes compared to HFMs is small although slightly increased for the TPMS membranes. There is no significant difference between the TPMS structures and the hollow fiber design. Nevertheless, the ratio between the achieved additional oxygen transfer and the additional hemolysis favors the TPMS‐based membrane shapes. Conclusion: TPMS‐shaped membranes offer a safe way to improve gas transfer in artificial lungs. [ABSTRACT FROM AUTHOR]

Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device‐related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel‐based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell‐based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) has become a mainstay of therapy for patients suffering from severe respiratory failure. Ambulatory ECMO systems aim to provide long‐term out‐of‐hospital respiratory support. As a patient's activity level changes, the required level of ECMO support varies with oxygen consumption and metabolic fluctuations. To compensate for such changes, an autoregulatory ECMO system (AR‐ECMO) has been developed and its performance was evaluated as a proof of concept in an acute ovine model. The AR‐ECMO system consists of a regular ECMO circuit and an electromechanical control system. A custom fuzzy logic control algorithm was implemented to adjust the blood flow and sweep gas flow of the ECMO circuit to meet the varying respiratory demand by utilizing two noninvasive sensors for venous oxyhemoglobin saturation and the oxygenator exhaust gas CO2 concentration. Disturbance responses of the AR‐ECMO to induced acute respiratory distress were assessed for six hours in four juvenile sheep cannulated with a veno‐pulmonary artery ECMO configuration, including acute ventilator shutoff, ventilator step change (off‐on‐off), and forced desaturation. All sheep survived for the study duration. The AR‐ECMO system was able to respond and maintain stable hemodynamics and physiological blood gas contents (SpO2 = 96.3 % ± 4.29, pH 7.44 ± 0.09, pCO2 = 38.9 ± 9.9 mm Hg, and pO2 =237.9 ± 123.6 mm Hg) during simulated respiratory distress. Acceptable correlation between oxygenator exhaust gas CO2 and oxygenator outlet pCO2 were observed (R2 = 0.84). In summary, the AR‐ECMO system successfully maintained physiologic control of peripheral oxygenation and carbon dioxide over the study period, utilizing only measurements taken directly from the ECMO circuit. The range of system response necessitates an adaptable system in the setting of variable metabolic demands. The ability of this system to respond to significant disturbances in ventilator support is encouraging. Future work to evaluate our AR‐ECMO system in long‐term, awake animal studies is necessary for further refinement. [ABSTRACT FROM AUTHOR]

Abstract: Under physiological conditions, up to 97% of the oxygen in blood that is transported from lungs to tissue is bound to hemoglobin. To predict oxygen transfer in artificial lungs on a membrane fiber level with computational fluid dynamics (CFD), previous investigators have incorporated the hemoglobin‐oxygen interaction into an effective diffusivity coefficient to modify the convection‐diffusion equation. Based on our own simulations and experiments, these approaches tend to significantly overestimate the oxygen transfer. The present study introduces a novel approach to model the oxygen transfer in blood on a fiber level with CFD. Plasma and red blood cells were implemented as two phases and the reaction of hemoglobin and oxygen to oxyhemoglobin was included in the convection‐diffusion equation in form of a source term. The model was implemented with the commercial software Ansys CFX 18.1. CFD simulations were compared with in vitro experiments on three micro oxygenators with a staggered fiber configuration under multiple blood flow conditions. To calibrate the model, a reaction rate R0 was introduced and experimental data was fitted to a blood flow of 50 mL/h. Our model approximated the oxygen transfer rates with a difference, relative to in vitro results, of −23.7 and +6.3% for blood flows of 20 and 90 mL/h, respectively. The effective diffusivity model, used by previous authors, was implemented for comparison and approximated oxygen transfer rates with a difference, relative to in vitro data, of +13.7, +68.8, and +121.0% for blood flows of 20, 50, and 90 mL/h, respectively. A well‐established numerical mass transfer correlation approximated the gas transfer with a difference, referenced on the average in vitro data, of 31.8, 13.1, and 5.0% for blood flows of 20, 50, and 90 mL/h, respectively. Even though results are promising, a thorough validation of the model will require extensive CFD and in vitro studies of multiple fiber arrangements, fiber diameters, and therefore fiber bundle porosities in the future. This article should be understood as a first feasibility study to evaluate the potential of the novel oxygen transfer model. [ABSTRACT FROM AUTHOR]

Polyethylene glycol (PEG) and heparin (Hep) were grafted onto polysulfone (PSF) membrane by plasma-induced surface modification to prepare PSF-PEG-Hep membranes used for artificial lung. The effects of plasma treatment parameters, including power, gas type, gas flow rate, and treatment time, were investigated, and different PEG chains were bonded covalently onto the surface in the postplasma grafting process. Membrane surfaces were characterized by water contact angle, PEG grafting degree, attenuated total reflectance-Fourier transform infrared spectroscopy, ultraviolet-visible spectrophotometry, X-ray photoelectron spectroscopy, critical water permeability pressure, and scanning electron microscopy. Protein adsorption, platelet adhesion, and coagulation tests showed significant improvement in the hemocompatibility of PSF-PEG-Hep membranes compared to pristine PSF membrane. Gas exchange tests through PSF-PEG6000-Hep membrane showed that when the flow rate of porcine blood reached 5.0 L/min, the permeation fluxes of O2 and CO2 reached 192.6 and 166.9 mL/min, respectively, which were close to the gas exchange capacity of a commercial membrane oxygenator. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1737-1746, 2017. [ABSTRACT FROM AUTHOR]

Respiratory failure is one of the major causes of mortality and morbidity all over the world. Therapeutic options to treat respiratory failure remain limited. The objective of this study was to evaluate the gas transfer performance of a newly developed miniature portable integrated pediatric pump-lung device (PediPL) with small membrane surface for respiratory support in an acute ovine respiratory failure model. The respiratory failure was created in six adult sheep using intravenous anesthesia and reduced mechanical ventilation at 2 breaths/min. The PediPL device was surgically implanted and evaluated for respiratory support in a venovenous configuration between the right atrium and pulmonary artery. The hemodynamics and respiratory status of the animals during support with the device gas transfer performance of the PediPL were studied for 4 h. The animals exhibited respiratory failure 30 min after mechanical ventilation was reduced to 2 breaths/min, indicated by low oxygen partial pressure, low oxygen saturation, and elevated carbon dioxide in arterial blood. The failure was reversed by establishing respiratory support with the PediPL after 30 min. The rates of O2 transfer and CO2 removal of the PediPL were 86.8 and 139.1 mL/min, respectively. The results demonstrated that the PediPL (miniature integrated pump-oxygenator) has the potential to provide respiratory support as a novel treatment for both hypoxia and hypercarbia. The compact size of the PediPL could allow portability and potentially be used in many emergency settings to rescue patients suffering acute lung injury. [ABSTRACT FROM AUTHOR]

Hollow fiber artificial lungs are increasingly being used for long-term applications. However, clot formation limits their use to 1-2 weeks. This study investigated the effect of nitric oxide generating (NOgen) hollow fibers on artificial lung thrombogenicity. Silicone hollow fibers were fabricated to incorporate 50 nm copper particles as a catalyst for NO generation from the blood. Fibers with and without (control) these particles were incorporated into artificial lungs with a 0.1 m2 surface area and inserted in circuits coated tip-to-tip with the NOgen material. Circuits ( N = 5/each) were attached to rabbits in a pumpless, arterio-venous configuration and run for 4 h at an activated clotting time of 350-400 s. Three control circuits clotted completely, while none of the NOgen circuits failed. Accordingly, blood flows were significantly higher in the NOgen group (95.9 ± 11.7, p < 0.01) compared to the controls (35.2 ± 19.7; mL/min), and resistance was significantly higher in the control group after 4 h (15.38 ± 9.65, p < 0.001) than in NOgen (0.09 ± 0.03; mmHg/mL/min). On the other hand, platelet counts and plasma fibrinogen concentration expressed as percent of baseline in control group (63.7 ± 5.7%, 77.2 ± 5.6%; p < 0.05) were greater than those in the NOgen group (60.4 ± 5.1%, 63.2 ± 3.7%). Plasma copper levels in the NOgen group were 2.8 times baseline at 4 h (132.8 ± 4.5 μg/dL) and unchanged in the controls. This study demonstrates that NO generating gas exchange fibers could be a potentially effective way to control coagulation inside artificial lungs. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 101A: 3511-3519, 2013. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for several lung and heart diseases in the field of neonatal and pediatric medicine (e.g., acute respiratory distress syndrome, congenital heart failure, cardiomyopathy). Current ECMO systems are typically composed of an oxygenator and a separate nonpulsatile blood pump. An oxygenator with an integrated pulsatile blood pump for small infant ECMO was developed, and this novel concept was tested regarding functionality and gas exchange rate. Pulsating silicone tubes (STs) were driven by air pressure and placed inside the cylindrical fiber bundle of an oxygenator to be used as a pump module. The findings of this study confirm that pumping blood with STs is a viable option for the future. The maximum gas exchange rate for oxygen is 48 mL/min/L at a medium blood flow rate of about 300 mL/min. Future design steps were identified to optimize the flow field through the fiber bundle to achieve a higher gas exchange rate. First, the packing density of the hollow-fiber bundle was lower than commercial oxygenators due to the manual manufacturing. By increasing this packing density, the gas exchange rate would increase accordingly. Second, distribution plates for a more uniform blood flow can be placed at the inlet and outlet of the oxygenator. Third, the hollow-fiber membranes can be individually placed to ensure equal distances between the surrounding hollow fibers. [ABSTRACT FROM AUTHOR]

Hollow fiber membrane (HFM)-based artificial lungs can require a large blood-contacting membrane surface area to provide adequate gas exchange. However, such a large surface area presents significant challenges to hemocompatibility. One method to improve carbon dioxide (CO2) transfer efficiency might be to immobilize carbonic anhydrase (CA) onto the surface of conventional HFMs. By catalyzing the dehydration of bicarbonate in blood, CA has been shown to facilitate diffusion of CO2 toward the fiber membranes. This study evaluated the impact of surface modifying a commercially available microporous HFM-based artificial lung on fiber blood biocompatibility. A commercial poly(propylene) Celgard HFM surface was coated with a siloxane, grafted with amine groups, and then attached with CA which has been shown to facilitate diffusion of CO2 toward the fiber membranes. Results following acute ovine blood contact indicated no significant reduction in platelet deposition or activation with the siloxane coating or the siloxane coating with grafted amines relative to base HFMs. However, HFMs with attached CA showed a significant reduction in both platelet deposition and activation compared with all other fiber types. These findings, along with the improved CO2 transfer observed in CA modified fibers, suggest that its incorporation into HFM design may potentiate the design of a smaller, more biocompatible HFM-based artificial lung. [ABSTRACT FROM AUTHOR]

Respiratory assist using intravenous catheters may be a potential therapy for patients with acute and acute-on-chronic lung failure. An important design constraint is respiratory catheter size, and new strategies are needed that enable size reduction while maintaining adequate gas exchange. Our group is currently developing a percutaneous respiratory assist catheter (PRAC) that uses a rotating bundle of hollow fiber membranes to enhance CO2 removal and O2 supply with increasing bundle rotation rate. In this study, particle image velocimetry (PIV) was used to analyze the fluid flow patterns and velocity fields surrounding the rotating fiber bundle of the PRAC. The goal of the study was to assess the rotational flow patterns within the context of the gas exchange enhancement that occurs with increasing fiber bundle rotation. A PRAC prototype was placed in a 1-in. internal diameter test section of an in vitro flow loop designed specifically for PIV studies. The rotation rate of the PRAC was varied between 500 and 7000 rpm, and PIV was used to determine the velocity fields in the primary ( r-θ) and secondary ( r- z) flow planes. The secondary flow exhibited time-varying and incoherent vortices that were consistent with the classical Taylor vortices expected for Taylor numbers (Ta) corresponding to the rotation speeds studied (2200 < Ta < 31 000). In the primary flow, the tangential velocity exhibited boundary layers of less than ½ mm adjacent to the fiber bundle and vessel wall. The estimated shear stress associated with the Taylor vortices was approximately 11 dyne/cm2 at 7000 rpm and was over 10 times smaller than the shear stress in the primary flow boundary layers. [ABSTRACT FROM AUTHOR]

The analyses performed in this paper reveal that a breathing thermal manikin with realistic simulation of respiration including breathing cycle, pulmonary ventilation rate, frequency and breathing mode, gas concentration, humidity and temperature of exhaled air and human body shape and surface temperature is sensitive enough to perform reliable measurement of characteristics of air as inhaled by occupants. The temperature, humidity, and pollution concentration in the inhaled air can be measured accurately with a thermal manikin without breathing simulation if they are measured at the upper lip at a distance of <0.01 m from the face. Body surface temperature, shape and posture as well as clothing insulation have impact on the measured inhaled air parameters. Proper simulation of breathing, especially of exhalation, is needed for studying the transport of exhaled air between occupants. A method for predicting air acceptability based on inhaled air parameters and known exposure–response relationships established in experiments with human subjects is suggested. Practical Implications Recommendations for optimal simulation of human breathing by means of a breathing thermal manikin when studying pollution concentration, temperature and humidity of the inhaled air as well as the transport of exhaled air (which may carry infectious agents) between occupants are outlined. In order to compare results obtained with breathing thermal manikins, their nose and mouth geometry should be standardized. [ABSTRACT FROM AUTHOR]

To treat acute lung failure, an intravenous membrane gas exchange device, the Hattler Catheter, is currently under development. Several methods were employed to evaluate the biocompatibility of the device during preclinical testing in bovines, and potential coatings for the fibers comprising the device were screened for their effectiveness in reducing thrombus deposition in vitro. Flow cytometric analysis demonstrated that the device had the capacity to activate platelets as evidenced by significant increases in circulating platelet microaggregates and activated platelets. Thrombus was observed on 20 ± 6% of the surface area of devices implanted for up to 53 h. Adding aspirin to the antithrombotic therapy permitted two devices to remain implanted up to 96 h with reduced platelet activation and only 3% of the surface covered with thrombus. The application of heparin-based coatings significantly reduced thrombus deposition in vitro. The results suggest that with the use of appropriate antithrombotic therapies and surface coatings the Hattler Catheter might successfully provide support for acute lung failure without thrombotic complications. [ABSTRACT FROM AUTHOR]

A finite volume-based computational model was developed to investigate the uniformity of the fluid flow across the hollow fiber membranes in blood oxygenation devices. A two-dimensional annular cross section of a blood oxygenation device including about 3300 hollow fiber membranes was used in the computation model. The equations governing the steady incompressible laminar flow in the blood oxygenation device were solved numerically and the results were compared with those obtained from the equivalent porous medium approximation. For the porous medium approximation, the Ergun equation was used for evaluating the permeability. The simulation results showed that the fluid molecules spend about six times longer in the fiber bundle region than that in its equivalent porous medium approximation model. The computational model also provides a more detailed fluid flow pattern in the membrane compartment of the blood oxygenator. [ABSTRACT FROM AUTHOR]

Three-dimensional computational fluid dynamic (CFD) simulations of membrane oxygenators should allow prediction of spatially dependent variables and subsequent shape optimization. Fiber bed complexity and current computational limitations require the use of approximate models to predict fiber drag effects in complete device simulations. A membrane oxygenator was modified to allow pressure measurement along the fiber bundle in all cardinal axes. Experimental pressure drop information with water perfusion was used to calculate the permeability of the fiber bundle. A three-dimensional CFD model of a commercial membrane oxygenator was developed to predict pressure drops throughout the device. Darcy's Law was used to account for the viscous drag of the fibers and was incorporated as a momentum loss term in the conservation equations. Close agreement was shown between experimental and simulated pressure drops at lower flow rates, but the simulated pressure drops were lower than experimental results at higher flows. Alternate models of fiber drag effects and flow field visualization are suggested as means to potentially improve the accuracy of the flow simulation. Computational techniques coupled with experimental verification offer insight into model validity and show promise for the development of accurate three-dimensional simulations of membrane oxygenators. [ABSTRACT FROM AUTHOR]

We developed an extracorporeal membrane oxygenation (ECMO) system with high antithrombogenicity and durability characteristics for prolonged continuous cardiopulmonary support. The oxygenator consists of a special hollow-fiber-type polyolefin gas-exchange membrane, which has an ultrathin dense layer in contact with the blood, in order to prevent plasma leakage during protracted use (Platinum Cube NCVC). The centrifugal pump (RotaFlow) is free of seals. The entire blood-contacting surface of the system is coated with a newly developed heparin material (Toyobo-NCVC coating). We performed a venoarterial bypass in a goat, and the ECMO system was driven for 34 days without systemic anticoagulants. Plasma leakage from the oxygenator did not occur, and sufficient gas exchange performance was maintained. Thrombus formation was hardly observed in the ECMO system except in the casing margins of the oxygenator. This ECMO system showed potential for long-term cardiopulmonary support with minimal or no use of systemic anticoagulants. [ABSTRACT FROM AUTHOR]

An intraluminal membrane oxygenator (IMO) prototype was surgically inserted in the ileum and evaluated as a method of supporting systemic oxygenation in an acutely hypoxemic porcine model. Animals were assigned randomly to the test (n = 12) or the control (n = 8) groups, which underwent identical protocols with the exception of the O2 flow in the IMO device, which was shut off in the control group. In each case, hypoxia was induced by a reduction in the inspired oxygen fraction (Fio2 ) to 0.14. A highly significant improvement (p < 0.005) in arterial and venous O2 content and lower arteriovenous O2 difference (p < 0.05), cardiac output, and hemoglobin (p < 0.005) were found in the test group during hypoxia. The results show that it is possible to meet a physiologically significant portion of the body's O2 demands via the intestine during respiratory hypoxia and suggests that similar devices may be of significant potential value as a supplemental oxygenation device in cases of respiratory distress. [ABSTRACT FROM AUTHOR]

A novel integrated heart-lung assist device has been developed as a simple to use portable cardiopulmonary support system. The device comprises a centrifugal pump and an artificial lung, which is located around the pump, in an all in one system. The special membrane employed precludes plasma breakthrough in protracted use and enables preprimed setup. Test lungs consisting of the same membrane preserved gas exchange function well after 3 months of preprimed storage. The entire blood contacting surface is treated with covalent heparin bonding to impart good antithrombogenicity. Heparin bonded test lungs could be continuously perfused without systemic anticoagulation as long as 36 days in a venoarterial bypass chronic animal study using goats. The prototype device (diameter, 126 mm; height, 59 mm; membrane area, 0.85 m2; priming volume, 180 ml) demonstrated 9 L/min pump output at a 400 mm Hg pressure head and 180 ml/min oxygen and 110 ml/min carbon dioxide transfer rates at 5 L/min blood flow. We conclude that this device has potential to be the next generation cardiopulmonary support system. [ABSTRACT FROM AUTHOR]