Abstract
BackgroundThere is increasing evidence demonstrating the value of partial extracorporeal CO2 removal (ECCO2R) for the treatment of hypercapnia in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory distress syndrome. Mechanical ventilation has traditionally been used to treat hypercapnia in these patients, however, it has been well-established that aggressive ventilator settings can lead to ventilator-induced lung injury. ECCO2R removes CO2 independently of the lungs and has been used to permit lung protective ventilation to prevent ventilator-induced lung injury, prevent intubation, and aid in ventilator weaning. The Low-Flow Pittsburgh Ambulatory Lung (LF-PAL) is a low-flow ECCO2R device that integrates the fiber bundle (0.65 m2) and centrifugal pump into a compact unit to permit patient ambulation.MethodsA blood analog was used to evaluate the performance of the pump at various impeller rotation rates. In vitro CO2 removal tested under normocapnic conditions and 6-h hemolysis testing were completed using bovine blood. Computational fluid dynamics and a mass-transfer model were also used to evaluate the performance of the LF-PAL.ResultsThe integrated pump was able to generate flows up to 700 mL/min against the Hemolung 15.5 Fr dual lumen catheter. The maximum vCO2 of 105 mL/min was achieved at a blood flow rate of 700 mL/min. The therapeutic index of hemolysis was 0.080 g/(100 min). The normalized index of hemolysis was 0.158 g/(100 L).ConclusionsThe LF-PAL met pumping, CO2 removal, and hemolysis design targets and has the potential to enable ambulation while on ECCO2R.
Highlights
There is increasing evidence demonstrating the value of partial extracorporeal CO2 removal (ECCO2R) for the treatment of hypercapnia in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory distress syndrome
ECCO2R has been used in patients with acute exacerbations of chronic obstructive pulmonary disease to avoid invasive mechanical ventilation, avoid intubation, or assist in extubation and in ventilator weaning [3,4,5]
May et al Intensive Care Medicine Experimental (2018) 6:34 distress syndrome (ARDS), ECCO2R has been used in conjunction with lung protective or ultra-protective ventilator settings to reduce ventilator-induced lung injury (VILI) and correct acidosis [7, 8]
Summary
There is increasing evidence demonstrating the value of partial extracorporeal CO2 removal (ECCO2R) for the treatment of hypercapnia in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory distress syndrome. ECCO2R removes CO2 independently of the lungs and has been used to permit lung protective ventilation to prevent ventilator-induced lung injury, prevent intubation, and aid in ventilator weaning. Mechanical ventilation is commonly used to help normalize arterial blood gases in patients with acute hypercapnia but can contribute to ventilator-induced lung injury (VILI). ECCO2R has been used in patients with acute exacerbations of chronic obstructive pulmonary disease (ae-COPD) to avoid invasive mechanical ventilation, avoid intubation, or assist in extubation and in ventilator weaning [3,4,5]. Blood acidification, electrodialysis, and carbonic anhydrase immobilization to the fiber surface are being explored in an effort to reduce fiber surface area and further lower blood flow rates [11,12,13,14]
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