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01.10.2015 | Original

A novel pump-driven veno-venous gas exchange system during extracorporeal CO₂-removal

verfasst von: Alexander Hermann, Katharina Riss, Peter Schellongowski, Andja Bojic, Philipp Wohlfarth, Oliver Robak, Wolfgang R. Sperr, Thomas Staudinger

Erschienen in: Intensive Care Medicine | Ausgabe 10/2015

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Abstract

Purpose

Pump-driven veno-venous extracorporeal CO₂-removal (ECCO₂-R) increasingly takes root in hypercapnic lung failure to minimize ventilation invasiveness or to avoid intubation. A recently developed device (iLA activve^®, Novalung, Germany) allows effective decarboxylation via a 22 French double lumen cannula. To assess determinants of gas exchange, we prospectively evaluated the performance of ECCO₂-R in ten patients receiving iLA activve^® due to hypercapnic respiratory failure.

Methods

Sweep gas flow was increased in steps from 1 to 14 L/min at constant blood flow (phase 1). Similarly, blood flow was gradually increased at constant sweep gas flow (phase 2). At each step gas transfer via the membrane as well as arterial blood gas samples were analyzed.

Results

During phase 1, we observed a significant increase in CO₂ transfer together with a decrease in PaCO₂ levels from a median of 66 mmHg (range 46–85) to 49 (31–65) mmHg from 1 to 14 L/min sweep gas flow (p < 0.0001), while arterial oxygenation deteriorated with high sweep gas flow rates. During phase 2, oxygen transfer significantly increased leading to an increase in PaO₂ from 67 (49–87) at 0.5 L/min to 117 (66–305) mmHg at 2.0 L/min (p < 0.0001). Higher blood flows also significantly enhanced decarboxylation (p < 0.0001).

Conclusions

Increasing sweep gas flow results in effective CO₂-removal, which can be further reinforced by raising blood flow. The clinically relevant oxygenation effect in this setting could broaden the range of indications of the system and help to set up an individually tailored configuration.

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Titel: A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal
verfasst von: Alexander Hermann
Katharina Riss
Peter Schellongowski
Andja Bojic
Philipp Wohlfarth
Oliver Robak
Wolfgang R. Sperr
Thomas Staudinger
Publikationsdatum: 01.10.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 10/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3957-0

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A novel pump-driven veno-venous gas exchange system during extracorporeal CO₂-removal