Toward Respiratory Support of Critically Ill COVID-19 Patients Using Repurposed Kidney Hollow Fiber Membrane Dialysers to Oxygenate the Blood.

David M. Rubin,Tonderayi Matambo,Claudia Do Vale,Mervyn Mer,Tracy Snyman,Martin J. Sussman,Neil T. Stacey,Diane Hildebrandt,Antonio Gloria

doi:10.1155/2020/8862645

Abstract

The COVID-19 pandemic has highlighted resource constraints in respiratory support. The oxygen transfer characteristics of a specific hollow fiber membrane dialyser was investigated with a view to repurposing the device as a low-cost, readily available blood oxygenator. Oxygen transfer in a low-flux hollow fiber dialyser with a polysulfone membrane was studied by passing first water and then blood through the dialyser in countercurrent to high-purity oxygen. Oxygen transfer rates of about 15% of the nominal 250 ml (STP)/min of a typical adult oxygen consumption rate were achieved for blood flow rates of 500 ml/min. Using two such dialysis devices in parallel could provide up to 30% of the nominal oxygen consumption. Specific hollow fiber dialysis devices operating with suitable pumps in a veno-venous access configuration could provide a cost-effective and readily available supplementation of respiratory support in the face of severe resource constraints.

Highlights

Introduction e COVID-19 pandemic has highlighted resource constraints in the management of respiratory distress [1], and debate continues on the merits of ventilation vs. less invasive respiratory support for COVID-19, in terms of disease management and safety of medical staff [2]
Oxygen was passed through the hollow fiber membrane dialysers (HFMDs) at 400 ml/min and water was run countercurrent through the inside of the hollow fibers
Measurement uncertainties for the blood gas analyser were approximated as 1% for pO2, pCO2, and haemoglobin concentration (Hb) and 0.1% for haemoglobin saturation (HbSat) based on the reported coefficient of variation data [12, 13]. e high values for pCO2 are in keeping with known changes in stored blood [14]

Summary

Introduction

Introduction e COVID19 pandemic has highlighted resource constraints in the management of respiratory distress [1], and debate continues on the merits of ventilation vs. less invasive respiratory support for COVID-19, in terms of disease management and safety of medical staff [2]. Extracorporeal membrane oxygenators (ECMOs) have been used successfully to oxygenate and decarbonate blood [3, 4], and there are a number of indications for the use of ECMO [5]. Its use is costly and resource intensive [6]. Our objective is not to replace ECMO but rather to investigate repurposing of renal hollow fiber membrane dialysers (HFMDs) as cost-effective augmentation of respiratory support in resource-constrained environments. Unlike purpose-designed ECMO membranes [7, 8], renal dialysis membranes are designed for liquid-liquid transfer of specific molecules.

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Conclusion