Progress Toward a Portable Artificial Lung: A Systematic Review.

BACKGROUND: Chronic respiratory diseases are the third leading global cause of death. As lung transplantation is a definitive treatment for highly selected candidates, extracorporeal membrane oxygenation (ECMO) can be a life-sustaining therapy. Standard ECMO therapy immobilizes the patient, which increases morbidity and mortality. There is a need for a portable venovenous (VV)-ECMO device that allows hospital ambulation and ultimately home use. AIM: This systematic review aims to identify clinically utilized and preclinical portable respiratory assist devices and describe their efficiency, progress, and innovative design features. METHOD: A comprehensive systematic search was conducted in six databases: PubMed, Cochrane, EMBASE, Inspect Engineering Village, ScienceDirect, and Journal of Heart and Lung Transplantation until July 25, 2025. A total of 562 articles were screened, and 16 were included. RESULTS: Eight portable respiratory assist devices were identified. Among these, the CE-marked MobyBox and the FDA-approved Breethe OXY-1 system are in clinical use. Two devices, the APL and the PAAL, are no longer in active development but have each laid the foundation for the Breethe OXY-1 system and the ModELAS device. Additionally, implementation of the PAL machine was not completed but led to the development of the double-lumen cannula. The remaining three portable ECMO devices are still undergoing preclinical testing. CONCLUSION: Several different portable ECMO devices have been developed, demonstrating substantial progress toward portable extracorporeal support. However, optimized anticoagulation strategies and safe mobilization require further investigation before widespread clinical adaptation. TRIAL REGISTRATION: PROSPERO registration number: CRD420251051796.