Artificial Lungs for Lung Failure in the Era of COVID-19 Pandemic: Contemporary Review

Abstract

In patients with severe acute respiratory distress syndrome caused by coronavirus 2019 (COVID-19), mortality remains high despite optimal medical management. Extracorporeal membrane oxygenation (ECMO) has been widely used to support such patients. ECMO is not a perfect solution; however, there are several limitations and serious complications associated with ECMO use. Moreover, the overall short-term mortality rate of patients with COVID-19 supported by ECMO is high (~30%). Some patients who survive severe acute respiratory distress syndrome have chronic lung failure requiring oxygen supplementation, long-term mechanical ventilation, or ECMO support. Although lung transplant remains the most effective treatment for patients with end-stage lung failure from COVID-19, optimal patient selection and transplant timing for patients with COVID-19-related lung failure are not clear. Access to an artificial lung (AL) that can be used for long-term support as a bridge to transplant, bridge to recovery, or even destination therapy will become increasingly important. In this review, we discuss why the COVID-19 pandemic may drive progress in AL technology, challenges to AL implementation, and how some of these challenges might be overcome.

FIGURE 1.

Mechanical respiratory-assist options for supporting patients with lung failure because of coronavirus 2019 (COVID-19). These are ideal device options for supporting patients with lung failure caused by COVID-19; however, there are still unmet needs. AL, artificial lung; BTR, bridge to recovery; BTT, bridge to transplant; CARDS, COVID-19–related acute respiratory distress syndrome; DT, destination therapy; ECMO, extracorporeal membrane oxygenator; PCPF, post-COVID pulmonary fibrosis; RVAD-Oyx, right ventricular-assist device with an oxygenator.