Impact of sweep gas flow on extracorporeal CO2 removal (ECCO2R)

• Background: Veno-venous extracorporeal carbon dioxide (CO2) removal (vv-ECCO2R) is increasingly being used in the setting of acute respiratory failure. Blood flow rates range in clinical practice from 200mL/min to more than 1500mL/min, and sweep gas flow rates range from less than 1 to more than 10L/min. The present porcine model study was aimed at determining the impact of varying sweep gas flow rates on CO2 removal under different blood flow conditions and membrane lung surface areas.Methods: Two different membrane lungs, with surface areas of 0.4 and 0.8m(2), were used in nine pigs with experimentally-induced hypercapnia. During each experiment, the blood flow was increased stepwise from 300 to 900 mL/min, with further increases up to 1800 mL/min with the larger membrane lung in steps of 300 mL/min. Sweep gas was titrated under each condition from 2 to 8L/min in steps of 2 L/min. Extracorporeal CO2 elimination was normalized to a PaCO2 of 45 mmHg before the membrane lung.Results: Reversal of hypercapnia was only feasible when blood flow rates above 900mL/min were used with a membrane lung surface area of at least 0.8m(2). The membrane lung with a surface of 0.4m(2) allowed a maximum normalized CO2 elimination rate of 416mL/min with 8L/min sweep gas flow and 900mLbloodflow/min. The increase in sweep gas flow from 2 to 8L/min increased normalized CO2 elimination from 35 +/- 5 to 41 +/- 6 with 900mLbloodflow/min, whereas with lower blood flow rates, any increase was less effective, levelling out at 4Lsweepgasflow/min. The membrane lung with a surface area of 0.8 m(2) allowed a maximum normalized CO2 elimination rate of 101 +/- 12 mL/min with increasing influence of sweep gas flow. The delta of normalized CO2 elimination increased from 4 +/- 2 to 26 +/- 7 mL/min with blood flow rates being increased from 300 to 1800 mL/min, respectively.Conclusions: The influence of sweep gas flow on the CO2 removal capacity of ECCO2R systems depends predominantly on blood flow rate and membrane lung surface area. In this model, considerable CO2 removal occurred only with the larger membrane lung surface of 0.8m(2) and when blood flow rates of >= 900mL/min were used.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

ARDS

Extracorporeal carbon dioxide removal

COPD

ECCO2R

ECMO

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