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Review
. 2012 Sep 21;16(5):232.
doi: 10.1186/cc11356.

Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future

Matthew E Cove, Graeme MacLaren, William J Federspiel, John A Kellum
Review

Bench to bedside review: Extracorporeal carbon dioxide removal, past present and future

Matthew E Cove et al. Crit Care. .

Abstract

Acute respiratory distress syndrome (ARDS) has a substantial mortality rate and annually affects more than 140,000 people in the USA alone. Standard management includes lung protective ventilation but this impairs carbon dioxide clearance and may lead to right heart dysfunction or increased intracranial pressure. Extracorporeal carbon dioxide removal has the potential to optimize lung protective ventilation by uncoupling oxygenation and carbon dioxide clearance. The aim of this article is to review the carbon dioxide removal strategies that are likely to be widely available in the near future. Relevant published literature was identified using PubMed and Medline searches. Queries were performed by using the search terms ECCOR, AVCO2R, VVCO2R, respiratory dialysis, and by combining carbon dioxide removal and ARDS. The only search limitation imposed was English language. Additional articles were identified from reference lists in the studies that were reviewed. Several novel strategies to achieve carbon dioxide removal were identified, some of which are already commercially available whereas others are in advanced stages of development.

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Figures

Figure 1
Figure 1
Diagram demonstrating essential components of an extracorporeal carbon dioxide removal circuit.
Figure 2
Figure 2
Diagram showing the basic principle of a membrane lung. Sweep gas passes through the hollow fibres. Hollow fibers are arranged in a complex mat. Image courtesy of Medos Medizintechnik AG (Stolberg, Germany).
Figure 3
Figure 3
Image of the interventional lung assist (iLA), blood is propelled through the circuit by arterial pressure. Image courtesy of Novolung (GmbH, Hechingen, Germany).
Figure 4
Figure 4
Diagram showing the basic circuit design of the Decap (Hemodec, Salerno, Italy). Blood is pumped through a membrane lung in series with a dialysis filter, and ultrafiltrate is returned to the blood prior to the membrane. UF, ultrafiltrate.
Figure 5
Figure 5
Cross sectional diagram of Hemolung (Alung Technologies, Pittsburgh, USA) showing rotating core that accelerate blood to the surrounding fiber bundle. Adjacent image shows the Hemolung console. Courtesy of Alung Technologies (Pittsburgh, USA).
Figure 6
Figure 6
Diagram of the Hattler catheter showing the rigid hollow fiber bundle surrounding a pulsating ballon.
See this image and copyright information in PMC

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