Abstract
Extracorporeal carbon dioxide removal (ECCO2R) is an important technique to treat critical lung diseases such as exacerbated chronic obstructive pulmonary disease (COPD) and mild or moderate acute respiratory distress syndrome (ARDS). This study applies our previously presented ECCO2R mock circuit to compare the CO2 removal capacity of circular versus parallel-plated membrane lungs at different sweep gas flow rates (0.5, 2, 4, 6 L/min) and blood flow rates (0.3 L/min, 0.9 L/min). For both designs, two low-flow polypropylene membrane lungs (Medos Hilte 1000, Quadrox-i Neonatal) and two mid-flow polymethylpentene membrane lungs (Novalung Minilung, Quadrox-iD Pediatric) were compared. While the parallel-plated Quadrox-iD Pediatric achieved the overall highest CO2 removal rates under medium and high sweep gas flow rates, the two circular membrane lungs performed relatively better at the lowest gas flow rate of 0.5 L/min. The low-flow Hilite 1000, although overall better than the Quadrox i-Neonatal, had the most significant advantage at a gas flow of 0.5 L/min. Moreover, the circular Minilung, despite being significantly less efficient than the Quadrox-iD Pediatric at medium and high sweep gas flow rates, did not show a significantly worse CO2 removal rate at a gas flow of 0.5 L/min but rather a slight advantage. We suggest that circular membrane lungs have an advantage at low sweep gas flow rates due to reduced shunting as a result of their fiber orientation. Efficiency for such low gas flow scenarios might be relevant for possible future portable ECCO2R devices.
Highlights
Extracorporeal lung support is a promising tool to treat critical lung diseases such as exacerbated chronic obstructive pulmonary disease (COPD), or mild or moderate acute respiratory distress syndrome (ARDS), where gas exchange is restricted [1,2]
The main advantage of the application of ECCO2R is the prevention of hypercapnia and respiratory acidosis induced by the reduced ventilation [2,3,6]
The primary circuit consisted of a Getinge Quadrox PLS (Permanent Life Support) membrane lung built into a loop circuit with a Rotaflow centrifugal pump and 3/8 polyvinyl chloride (PVC) tubings
Summary
Extracorporeal lung support is a promising tool to treat critical lung diseases such as exacerbated COPD, or mild or moderate ARDS, where gas exchange is restricted [1,2]. Two major methods: Extra corporeal membrane oxygenation (ECMO), used for oxygenation and CO2 removal of patients in hypoxic and hypercapnic respiratory failure and extracorporeal carbon dioxide removal (ECCO2R) only applied in hypercapnic respiratory failure to remove surplus carbon dioxide [3]. The main goal of applying those extracorporeal therapies is, to ensure a sufficient gas exchange and lung protective ventilation to prevent the lung from further damage by invasive ventilation. Ultra-lung-protective ventilation that uses tidal volumes
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