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. 2014 Jun 17;18(3):R124.
doi: 10.1186/cc13928.

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

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

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

Christian Karagiannidis et al. Crit Care. .

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 m(2) 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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Figures

Figure 1
Figure 1
Elimination of carbon dioxide (CO2) depending on blood flow. A) 14.5Fr catheter; 8 L/minute sweep gas flow. B) 14.5Fr catheter; 16 L/minute sweep gas flow. C) 19Fr catheter; 8 L/minute sweep gas flow. D) 19Fr catheter; 16 L/minute sweep gas flow. Fr, French.
Figure 2
Figure 2
Partial pressure of arterial carbon dioxide (PaCO2) depending on blood flow. A) 14.5Fr catheter; 8 L/minute sweep gas flow. B) 14.5Fr catheter; 16 L/minute sweep gas flow. C) 19Fr catheter; 8 L/minute sweep gas flow. D) 19Fr catheter; 16 L/minute sweep gas flow. Fr, French.
Figure 3
Figure 3
pH dependence on blood flow. A) 14.5Fr catheter; 8 L/minute sweep gas flow. B) 14.5Fr catheter; 16 L/minute sweep gas flow. C) 19Fr catheter; 8 L/minute sweep gas flow. D) 19Fr catheter; 16 L/minute sweep gas flow. Fr, French.
Figure 4
Figure 4
Normalized elimination of carbon dioxide (CO2) depending on blood flow. A) 14.5Fr catheter; 8 L/minute sweep gas flow. B) 14.5Fr catheter; 16 L/minute sweep gas flow. C) 19Fr catheter; 8 L/minute sweep gas flow. D) 19Fr catheter; 16 L/minute sweep gas flow.
Figure 5
Figure 5
Elimination of carbon dioxide (CO 2 ) in dependence of sweep gas flow under a fixed flood flow of 1,000 ml/minute using a 19Fr catheter. Fr, French.
Figure 6
Figure 6
Partial pressure of arterial (PaCO2) and venous (PvCO2) carbon dioxide depending on blood flow, sweep gas flow and cannula size. A) 14.5Fr catheter; 8 L/minute sweep gas flow. B) 14.5Fr catheter; 16 L/minute sweep gas flow. C) 19Fr catheter; 8 L/minute sweep gas flow. D) 19Fr catheter; 16 L/minute sweep gas flow. Fr, French.
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