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Open Access 01-06-2014 | Research

Veno-venous extracorporeal CO₂ removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations

Authors: Christian Karagiannidis, Kristin Aufm Kampe, Fernando Suarez Sipmann, Anders Larsson, Goran Hedenstierna, Wolfram Windisch, Thomas Mueller

Published in: Critical Care | Issue 3/2014

Abstract

Introduction

While non-invasive ventilation aimed at avoiding intubation has become the modality of choice to treat mild to moderate acute respiratory acidosis, many severely acidotic patients (pH <7.20) still need intubation. Extracorporeal veno-venous CO₂ removal (ECCO₂R) could prove to be an alternative. The present animal study tested in a systematic fashion technical requirements for successful ECCO₂R in terms of cannula size, blood and sweep gas flow.

Methods

ECCO₂R with a 0.98 m² surface oxygenator was performed in six acidotic (pH <7.20) pigs using either a 14.5 French (Fr) or a 19Fr catheter, with sweep gas flow rates of 8 and 16 L/minute, respectively. During each experiment the blood flow was incrementally increased to a maximum of 400 mL/minute (14.5Fr catheter) and 1000 mL/minute (19Fr catheter).

Results

Amelioration of severe respiratory acidosis was only feasible when blood flow rates of 750 to 1000 mL/minute (19Fr catheter) were used. Maximal CO₂-elimination was 146.1 ± 22.6 mL/minute, while pH increased from 7.13 ± 0.08 to 7.41 ± 0.07 (blood flow of 1000 mL/minute; sweep gas flow 16 L/minute). Accordingly, a sweep gas flow of 8 L/minute resulted in a maximal CO₂-elimination rate of 138.0 ± 16.9 mL/minute. The 14.5Fr catheter allowed a maximum CO₂ elimination rate of 77.9 mL/minute, which did not result in the normalization of pH.

Conclusions

Veno-venous ECCO₂R may serve as a treatment option for severe respiratory acidosis. In this porcine model, ECCO₂R was most effective when using blood flow rates ranging between 750 and 1000 mL/minute, while an increase in sweep gas flow from 8 to 16 L/minute had less impact on ECCO₂R in this setting.

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Title: Veno-venous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations
Authors: Christian Karagiannidis
Kristin Aufm Kampe
Fernando Suarez Sipmann
Anders Larsson
Goran Hedenstierna
Wolfram Windisch
Thomas Mueller
Publication date: 01-06-2014
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13928

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Veno-venous extracorporeal CO₂ removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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