Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 10/2015

01-10-2015 | Original

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

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

Published in: Intensive Care Medicine | Issue 10/2015

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Jayroe JB, Wang D, Deyo DJ, Alpard SK, Bidani A, Zwischenberger JB (2003) The effect of augmented hemodynamics on blood flow during arteriovenous carbon dioxide removal. ASAIO J 49:30–34CrossRefPubMed
2.
Schmidt M, Tachon G, Devilliers C, Muller G, Hekimian G, Brechot N, Merceron S, Luyt CE, Trouillet JL, Chastre J, Leprince P, Combes A (2013) Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensiv Care Med 39:838–846CrossRef
3.
Zimmermann M, Bein T, Arlt M, Philipp A, Rupprecht L, Mueller T, Lubnow M, Graf BM, Schlitt HJ (2009) Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Crit Care 13:R10PubMedCentralCrossRefPubMed
4.
Bein T, Weber-Carstens S, Goldmann A, Muller T, Staudinger T, Brederlau J, Muellenbach R, Dembinski R, Graf BM, Wewalka M, Philipp A, Wernecke KD, Lubnow M, Slutsky AS (2013) Lower tidal volume strategy (approximately 3 ml/kg) combined with extracorporeal CO2 removal versus ‘conventional’ protective ventilation (6 ml/kg) in severe ARDS : the prospective randomized Xtravent-study. Intensiv Care Med 39:847–856CrossRef
5.
Fischer S, Simon AR, Welte T, Hoeper MM, Meyer A, Tessmann R, Gohrbandt B, Gottlieb J, Haverich A, Strueber M (2006) Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J Thorac Cardiovasc Surg 131:719–723CrossRefPubMed
6.
Fischer S, Hoeper MM, Bein T, Simon AR, Gottlieb J, Wisser W, Frey L, Van Raemdonck D, Welte T, Haverich A, Strueber M (2008) Interventional lung assist: a new concept of protective ventilation in bridge to lung transplantation. ASAIO J 54:3–10CrossRefPubMed
7.
Kluge S, Braune SA, Engel M, Nierhaus A, Frings D, Ebelt H, Uhrig A, Metschke M, Wegscheider K, Suttorp N, Rousseau S (2012) Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensiv Care Med 38:1632–1639CrossRef
8.
Abrams DC, Brenner K, Burkart KM, Agerstrand CL, Thomashow BM, Bacchetta M, Brodie D (2013) Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc 10:307–314CrossRefPubMed
9.
Terragni P, Maiolo G, Ranieri VM (2012) Role and potentials of low-flow CO(2) removal system in mechanical ventilation. Curr Opin Crit Care 18:93–98CrossRefPubMed
10.
Hermann A, Staudinger T, Bojic A, Riss K, Wohlfarth P, Robak O, Sperr WR, Schellongowski P (2014) First experience with a new miniaturized pump-driven venovenous extracorporeal CO2 removal system (iLA Activve): a retrospective data analysis. ASAIO J 60:342–347CrossRefPubMed
11.
Lehle K, Philipp A, Hiller KA, Zeman F, Buchwald D, Schmid C, Dornia C, Lunz D, Muller T, Lubnow M (2014) Efficiency of gas transfer in venovenous extracorporeal membrane oxygenation: analysis of 317 cases with four different ECMO systems. Intensiv Care Med 40:1870–1877CrossRef
12.
Wearden PD, Federspiel WJ, Morley SW, Rosenberg M, Bieniek PD, Lund LW, Ochs BD (2012) Respiratory dialysis with an active-mixing extracorporeal carbon dioxide removal system in a chronic sheep study. Intensiv Care Med 38:1705–1711CrossRef
13.
Zhou X, Loran DB, Wang D, Hyde BR, Lick SD, Zwischenberger JB (2005) Seventy-two hour gas exchange performance and hemodynamic properties of NOVALUNG iLA as a gas exchanger for arteriovenous carbon dioxide removal. Perfusion 20:303–308CrossRefPubMed
14.
Muller T, Lubnow M, Philipp A, Bein T, Jeron A, Luchner A, Rupprecht L, Reng M, Langgartner J, Wrede CE, Zimmermann M, Birnbaum D, Schmid C, Riegger GA, Pfeifer M (2009) Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. Eur Respir J 33:551–558CrossRefPubMed
15.
Schellongowski P, Riss K, Staudinger T, Ullrich R, Krenn CG, Sitzwohl C, Bojic A, Wohlfarth P, Sperr WR, Rabitsch W, Aigner C, Taghavi S, Jaksch P, Klepetko W, Lang G (2014) Extracorporeal CO removal as bridge to lung transplantation in life-threatening hypercapnia. Transpl Int (Epub ahead of print)
16.
Mulholland JW, Massey W, Shelton JC (2000) Investigation and quantification of the blood trauma caused by the combined dynamic forces experienced during cardiopulmonary bypass. Perfusion 15:485–494CrossRefPubMed
17.
Slagt C, Helmi M, Malagon I, Groeneveld AB (2015) Calibrated versus uncalibrated arterial pressure waveform analysis in monitoring cardiac output with transpulmonary thermodilution in patients with severe sepsis and septic shock: an observational study. Eur J Anaesthesiol 32:5–12CrossRefPubMed
18.
Monnet X, Vaquer S, Anguel N, Jozwiak M, Cipriani F, Richard C, Teboul JL (2015) Comparison of pulse contour analysis by Pulsioflex and Vigileo to measure and track changes of cardiac output in critically ill patients. Br J Anaesth 114:235–243CrossRefPubMed
19.
Radermacher P, Santak B, Becker H, Falke KJ (1989) Prostaglandin E1 and nitroglycerin reduce pulmonary capillary pressure but worsen ventilation-perfusion distributions in patients with adult respiratory distress syndrome. Anesthesiology 70:601–606CrossRefPubMed
Metadata
Title
A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal
Authors
Alexander Hermann
Katharina Riss
Peter Schellongowski
Andja Bojic
Philipp Wohlfarth
Oliver Robak
Wolfgang R. Sperr
Thomas Staudinger
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-3957-0

Other articles of this Issue 10/2015

Intensive Care Medicine 10/2015 Go to the issue

Original

Left ventricular global longitudinal strain is independently associated with mortality in septic shock patients

Editorial

Should cost considerations be included in medical decisions? No

Imaging in Intensive Care Medicine

Prone positioning induced hepatic necrosis after liver transplantation

Systematic Review

Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review

Correspondence

Hyperoxia: is it a biomarker for mortality?

Understanding the Disease

Understanding the Russell equation and projection estimates to describe critical care costs in the USA