Abstract
BackgroundExtracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease. Herein, we describe a new mock circuit that enables experimental ECCO2R research without animal models. In a second step, we use this model to investigate three experimental scenarios of ECCO2R: (I) the influence of hemoglobin concentration on CO2 removal. (II) a potentially portable ECCO2R that uses air instead of oxygen, (III) a low-flow ECCO2R that achieves effective CO2 clearance by recirculation and acidification of the limited blood volume of a small dual lumen cannula (such as a dialysis catheter).ResultsWith the presented ECCO2R mock, CO2 removal rates comparable to previous studies were obtained. The mock works with either fresh porcine blood or diluted expired human packed red blood cells. However, fresh porcine blood was preferred because of better handling and availability. In the second step of this work, hemoglobin concentration was identified as an important factor for CO2 removal. In the second scenario, an air-driven ECCO2R setup showed only a slightly lower CO2 wash-out than the same setup with pure oxygen as sweep gas. In the last scenario, the low-flow ECCO2R, the blood flow at the test membrane lung was successfully raised with a recirculation channel without the need to increase cannula flow. Low recirculation ratios resulted in increased efficiency, while high recirculation ratios caused slightly reduced CO2 removal rates. Acidification of the CO2 depleted blood in the recirculation channel caused an increase in CO2 removal rate.ConclusionsWe demonstrate a simple and cost effective, yet powerful, “in-vitro” ECCO2R model that can be used as an alternative to animal experiments for many research scenarios. Moreover, in our approach parameters such as hemoglobin level can be modified more easily than in animal models.
Highlights
Extracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease
We demonstrate a simple and cost effective, yet powerful, “in-vitro” Extra corporal carbon dioxide removal (ECCO2R) model that can be used as an alternative to animal experiments for many research scenarios
ECCO2R may be used in the management of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) or patients waiting for lung
Summary
Extracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease. Extracorporeal carbon dioxide elimination (ECCO2R) is a method to counteract hypercapnic respiratory failure, e.g., in severe acute respiratory distress syndrome (ARDS). The invasiveness of catheters to generate a sufficient blood flow (BF), as well as mobility limitations due to heavy oxygen bottles, are burdens for potential mobile ECCO2R devices [5]. Another limitation of current ECCO2R devices is the exclusive permeability of the membrane lung (ML) for gaseous substances and the impermeability for dissolved bicarbonate [6]. Since the majority of carbon dioxide is transported as chemically bound HCO3−, only approximately 10% of the total CO2 can pass the ML, necessitating high extracorporeal blood flows to sufficiently deplete the blood of CO2 [6]
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