A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal
- 14 July 2015
- journal article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 41 (10), 1773-1780
- https://doi.org/10.1007/s00134-015-3957-0
Abstract
Pump-driven veno-venous extracorporeal CO2-removal (ECCO2-R) increasingly takes root in hypercapnic lung failure to minimize ventilation invasiveness or to avoid intubation. A recently developed device (iLA activve®, Novalung, Germany) allows effective decarboxylation via a 22 French double lumen cannula. To assess determinants of gas exchange, we prospectively evaluated the performance of ECCO2-R in ten patients receiving iLA activve® due to hypercapnic respiratory failure. Sweep gas flow was increased in steps from 1 to 14 L/min at constant blood flow (phase 1). Similarly, blood flow was gradually increased at constant sweep gas flow (phase 2). At each step gas transfer via the membrane as well as arterial blood gas samples were analyzed. During phase 1, we observed a significant increase in CO2 transfer together with a decrease in PaCO2 levels from a median of 66 mmHg (range 46–85) to 49 (31–65) mmHg from 1 to 14 L/min sweep gas flow (p < 0.0001), while arterial oxygenation deteriorated with high sweep gas flow rates. During phase 2, oxygen transfer significantly increased leading to an increase in PaO2 from 67 (49–87) at 0.5 L/min to 117 (66–305) mmHg at 2.0 L/min (p < 0.0001). Higher blood flows also significantly enhanced decarboxylation (p < 0.0001). Increasing sweep gas flow results in effective CO2-removal, which can be further reinforced by raising blood flow. The clinically relevant oxygenation effect in this setting could broaden the range of indications of the system and help to set up an individually tailored configuration.Keywords
This publication has 19 references indexed in Scilit:
- Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shockEuropean Journal of Anaesthesiology, 2015
- Extracorporeal CO2removal as bridge to lung transplantation in life-threatening hypercapniaTransplant International, 2014
- Efficiency of gas transfer in venovenous extracorporeal membrane oxygenation: analysis of 317 cases with four different ECMO systemsIntensive Care Medicine, 2014
- Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDSIntensive Care Medicine, 2013
- Respiratory dialysis with an active-mixing extracorporeal carbon dioxide removal system in a chronic sheep studyIntensive Care Medicine, 2012
- Role and potentials of low-flow CO2 removal system in mechanical ventilationCurrent Opinion in Critical Care, 2012
- Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacyEuropean Respiratory Journal, 2008
- Seventy-two hour gas exchange performance and hemodynamic properties of NOVALUNG®iLA as a gas exchanger for arteriovenous carbon dioxide removalPerfusion, 2005
- Investigation and quantification of the blood trauma caused by the combined dynamic forces experienced during cardiopulmonary bypassPerfusion, 2000
- Prostaglandin E1 and Nitroglycerin Reduce Pulmonary Capillary Pressure but Worsen Ventilation—Perfusion Distributions in Patients with Adult Respiratory Distress SyndromeAnesthesiology, 1989