Dataset Information

Evaluation of a New Extracorporeal CO₂ Removal Device in an Experimental Setting.

ABSTRACT:

Background

Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO₂ removal (ECCO₂R). We tested the CO₂ removal performance of a new ECCO₂R (CO₂RESET) device in an experimental animal model.

Methods

Three healthy pigs were mechanically ventilated and connected to the CO₂RESET device (surface area = 1.8?m², EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO₂ (target pre membrane lung venous PCO₂ (P_preCO₂): 80-120 mmHg). The amount of CO₂ removed (VCO₂, mL/min) by the membrane lung was assessed directly by the ECCO₂R device.

Results

Before the initiation of ECCO₂R, the median P_preCO₂ was 102.50 (95.30-118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO₂ progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00-200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO₂ was observed increasing the gas flow from 0 to 2 L/min, then, VCO₂ tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed.

Conclusions

Medium-flow ECCO₂R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m²) provided a high VCO₂ using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs.

SUBMITTER: Di Nardo M

PROVIDER: S-EPMC7823796 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Evaluation of a New Extracorporeal CO<sub>2</sub> Removal Device in an Experimental Setting.

Di Nardo Matteo M Annoni Filippo F Su Fuhong F Belliato Mirko M Lorusso Roberto R Broman Lars Mikael LM Malfertheiner Maximilian M Creteur Jacques J Taccone Fabio Silvio FS

Membranes 20201223 1

<h4>Background</h4>Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO<sub>2</sub> removal (ECCO<sub>2</sub>R). We tested the CO<sub>2</sub> removal performance of a new ECCO<sub>2</sub>R (CO<sub>2</sub>RESET) device in an experimental animal model.<h4>Methods</h4>Three healthy pigs were mechanically ventilated ...[more]

PMID: 33374762

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Project description:Background:Extracorporeal carbon dioxide removal (ECCO2R) is a promising technique for the management of acute respiratory failure, but with a limited level of evidence to support its use outside clinical trials and/or data collection initiatives. We report a collaborative initiative in a large metropolis. Methods:To assess on a structural basis the rate of utilization as well as efficacy and safety parameters of 2 ECCO2R devices in 10 intensive care units (ICU) during a 2-year period. Results:Seventy patients were recruited in 10 voluntary and specifically trained centers. The median utilization rate was 0.19 patient/month/center (min 0.04; max 1.20). ECCO2R was started under invasive mechanical ventilation (IMV) in 59 patients and non-invasive ventilation in 11 patients. The Hemolung Respiratory Assist System (Alung) was used in 53 patients and the iLA Activve iLA kit (Xenios Novalung) in 17 patients. Main indications were ultraprotective ventilation for ARDS patients (n?=?24), shortening the duration of IMV in COPD patients (n?=?21), preventing intubation in COPD patients (n?=?9), and controlling hypercapnia and dynamic hyperinflation in mechanically ventilated patients with severe acute asthma (n?=?6). A reduction in median V T was observed in ARDS patients from 5.9 to 4.1?ml/kg (p <0.001). A reduction in PaCO2 values was observed in AE-COPD patients from 67.5 to 51?mmHg (p<?0.001). Median duration of ECCO2R was 5?days (IQR 3-8). Reasons for ECCO2R discontinuation were improvement (n?=?33), ECCO2R-related complications (n?=?18), limitation of life-sustaining therapies or measures decision (n?=?10), and death (n?=?9). Main adverse events were hemolysis (n?=?21), bleeding (n?=?17), and lung membrane clotting (n?=?11), with different profiles between the devices. Thirty-five deaths occurred during the ICU stay, 3 of which being ECCO2R-related. Conclusions:Based on a registry, we report a low rate of ECCO2R device utilization, mainly in severe COPD and ARDS patients. Physiological efficacy was confirmed in these two populations. We confirmed safety concerns such as hemolysis, bleeding, and thrombosis, with different profiles between the devices. Such results could help to design future studies aiming to enhance safety, to demonstrate a still-lacking strong clinical benefit of ECCO2R, and to guide the choice between different devices. Trial registration:ClinicalTrials.gov: Identifier: NCT02965079 retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02965079.

Project description:Mechanical ventilation (MV) represents a lifesaving treatment for patients with respiratory failure, but it could be harmful through the development of ventilator-induced lung injury (VILI). In patients with acute respiratory distress syndrome (ARDS), protective MV strategies with low tidal volume to minimize VILI have been demonstrated to reduce lung injury and mortality. However, they can be limited by the emergence of uncontrolled hypercapnia. Similarly, in COPD patients, noninvasive MV failure often is associated with a progressive rise in arterial CO2 and need for endotracheal intubation, with higher risk of hospital mortality. Minimally invasive extracorporeal CO2 removal systems (ECCO2R) theoretically can remove the entire amount of the CO2 produced in the body per minute. In ARDS patients, ECCO2R may further reduce the risk of VILI ensuring ultraprotective MV and avoiding hypercapnia. In patients with exacerbation of COPD, ECCO2R may help to avoid intubation or facilitate weaning from invasive MV. In intensive care unit, concomitant renal and respiratory failure with MV is one of the strongest risk factors for hospital mortality. Combining ECCO2R and renal replacement therapy may support respiratory and renal functions and limit the side effects of MV. However, the need for systemic anticoagulation and the related risk of bleeding still represent a concern for a wider application of ECCO2R devices. In conclusion, ECCO2R is an effective support therapy to MV to limit its invasiveness and side effects, but its efficacy and safety must be proven in well-designed clinical trials. Objectives This chapter will:1 Explain the physiology of CO2 removal during extracorporeal support.2 Describe potential clinical applications of extracorporeal CO2 removal systems (ECCO2R) support therapy in patients with acute respiratory distress syndrome (ARDS) and chronic obstructive pulmonary disease (COPD) as well as in those with acute kidney injury requiring renal replacement therapy.

Dataset Information

Evaluation of a New Extracorporeal CO₂ Removal Device in an Experimental Setting.

Background

Methods

Results

Conclusions

Publications

Evaluation of a New Extracorporeal CO<sub>2</sub> Removal Device in an Experimental Setting.

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Tweets

Dataset Information

Evaluation of a New Extracorporeal CO2 Removal Device in an Experimental Setting.

Background

Methods

Results

Conclusions

Publications

Evaluation of a New Extracorporeal CO<sub>2</sub> Removal Device in an Experimental Setting.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Evaluation of a New Extracorporeal CO₂ Removal Device in an Experimental Setting.