Introduction

Over the last 50 years, we have seen remarkable progress in the area of cardiac support as it pertains to artificial organs. Artificial hearts and ventricular assist devices have changed the way we think about end-stage chronic heart failure. Yet the area of the artificial lung has lingered behind many of these accomplishments, not because the need was not recognized but because a full understanding of the engineering problems and the unique material requirements had not reached a level of development to be fully evident. This has changed, and at the centre of this progress has been a close collaboration between the clinician-scientist and the engineer. Here, the underlying concepts that are fundamental to gas exchange in blood have been instrumental in guiding research and in defining the haemodynamic impact on the host as it pertains to both extra- and intracorporeal artificial lung devices [1]. An overview of how this change has occurred and where it appears to be leading us is the subject of this chapter.

Background

Artificial lung technology can be broadly classified into current and next generation (Figure 29.1). What is presently available to clinicians derives from the pioneering work of John Gibbon and his contemporaries who, in the 1950s, developed the early prototypes of the heart–lung machine [2–5]. The goal of these pioneers was to support the heart and the lungs during heart surgery, and the objectives in the design of their oxygenators predicted many of the parameters for artificial lungs under current development.