In vitro characterization of PrismaLung+: a novel ECCO2R device

Ingeborg Hospach,Dominique Pouchoulin,Markus Storr,Manuela Raible,Stefanie Votteler,Jacques Goldstein,John G Laffey,Kai Harenski

doi:10.1186/s40635-020-00301-7

Abstract

BackgroundInvasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury. Advances in extracorporeal CO2 removal (ECCO2R) technologies may facilitate more protective lung ventilation in acute respiratory distress syndrome, and enable earlier weaning and/or avoid invasive mechanical ventilation entirely in chronic obstructive pulmonary disease exacerbations. We evaluated the in vitro CO2 removal capacity of the novel PrismaLung+ ECCO2R device compared with two existing gas exchangers.MethodsThe in vitro CO2 removal capacity of the PrismaLung+ (surface area 0.8 m2, Baxter) was compared with the PrismaLung (surface area 0.35 m2, Baxter) and A.L.ONE (surface area 1.35 m2, Eurosets) devices, using a closed-loop bovine blood–perfused extracorporeal circuit. The efficacy of each device was measured at varying pCO2 inlet (pinCO2) levels (45, 60, and 80 mmHg) and blood flow rates (QB) of 200–450 mL/min; the PrismaLung+ and A.L.ONE devices were also tested at a QB of 600 mL/min. The amount of CO2 removed by each device was assessed by measurement of the CO2 infused to maintain circuit equilibrium (CO2 infusion method) and compared with measured CO2 concentrations in the inlet and outlet of the CO2 removal device (blood gas analysis method).ResultsThe PrismaLung+ device performed similarly to the A.L.ONE device, with both devices demonstrating CO2 removal rates ~ 50% greater than the PrismaLung device. CO2 removal rates were 73 ± 4.0, 44 ± 2.5, and 72 ± 1.9 mL/min, for PrismaLung+, PrismaLung, and A.L.ONE, respectively, at QB 300 mL/min and pinCO2 45 mmHg. A Bland–Altman plot demonstrated that the CO2 infusion method was comparable to the blood gas analysis method for calculating CO2 removal. The resistance to blood flow across the test device, as measured by pressure drop, varied as a function of blood flow rate, and was greatest for PrismaLung and lowest for the A.L.ONE device.ConclusionsThe newly developed PrismaLung+ performed more effectively than PrismaLung, with performance of CO2 removal comparable to A.L.ONE at the flow rates tested, despite the smaller membrane surface area of PrismaLung+ versus A.L.ONE. Clinical testing of PrismaLung+ is warranted to further characterize its performance.

Highlights

Invasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury
CO2 removal rates at an increased blood flow rate of 600 mL/min were evaluated for the PrismaLung+ and A.L.ONE devices only and were comparable for both devices (p > 0.05) (Additional file 2: Figure S2)
As the volume flow of gases, i.e., the CO2 removal rate, is temperature- and pressure-dependent, data were calculated at standard reference conditions, 0 °C and 25 °C (STP as defined by International Union of Pure and Applied Chemistry (IUPAC)), in addition to the physiological conditions, 37 °C, for the PrismaLung+ device at a pinCO2 of 45 mmHg and blood flow rate (QB) range of 200– 450 mL/min (Fig. 3a)

Summary

Introduction

Invasive mechanical ventilation is lifesaving in the setting of severe acute respiratory failure but can cause ventilation-induced lung injury. Patients with severe acute hypoxemic and/or hypercapnic respiratory failure require invasive mechanical ventilation (IMV) to facilitate gas exchange and to support breathing. There is considerable interest in developing strategies such as extracorporeal CO2 removal (ECCO2R), which can facilitate CO2 removal [1], or extracorporeal membrane oxygenation (ECMO), which, in addition, provides oxygenation in instances of severe hypoxemic respiratory failure [2]. These approaches may enable reductions in the intensity and/or the duration of IMV in these patients. Amato et al showed that lower driving pressure was the physical variable that best correlated with survival in patients with ARDS [10]; higher positive end-expiratory pressure (PEEP), lower peak and plateau pressures, and lower respiratory rate, may be associated with improved survival [11, 12]

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Discussion

Conclusion