Extracorporeal carbon dioxide removal (ECCO2R) in respiratory deficiency and current investigations on its improvement: a review

Abstract

The implementation of extracorporeal carbon dioxide removal (ECCOR) as one of the extracorporeal life support system is getting more attention today. Thus, the objectives of this paper are to study the clinical practice of commercial ECCOR system, current trend of its development and also the perspective on future improvement that can be done to the existing ECCOR system. The strength of this article lies in its review scope, which focuses on the commercial ECCOR therapy in the market based on membrane lung and current investigation to improve the efficiency of the ECCOR system, in terms of surface modification by carbonic anhydrase (CA) immobilization technique and respiratory electrodialysis (R-ED). Our methodology approach involves the identification of relevant published literature from PubMed and Web of Sciences search engine using the terms Extracorporeal Carbon Dioxide Removal (ECCOR), Extracorporeal life support, by combining terms between ECCOR and CA and also ECCOR with R-ED. This identification only limits articles in English language. Overall, several commercial ECCOR systems are known and proven safe to be used in patients in terms of efficiency, safety and risk of complication. In addition, CA-modified hollow fiber for membrane lung and R-ED are proven to have good potential to be applied in conventional ECCOR design. The detailed technique and current progress on CA immobilization and R-ED development were also reviewed in this article.

Extracorporeal Membrane Oxygenation for Respiratory Failure

“…Future developments will focus on systems that maximize carbon dioxide removal with blood flows in the range of 200 to 250 ml/min. 144,145 Quite efficient devices (50-80 ml CO 2 /min) accomplish carbon dioxide removal by using bicorbonate dialysis while restoring normal blood pH with nonbicarbonate buffers, or by increasing the partial pressure of carbon dioxide gradient between premembrane blood and sweep gas. [145][146][147][148][149] The latter can be achieved, for example, by blood acidification 145,150,151 with lactate or citrate, 152 by carbonic anhydrase immobilized in a gas-liquid membrane 139,[153][154][155] (or, more commonly, on hollow fibers), or by respiratory electrodialysis.…”

Extracorporeal Carbon Dioxide Removal in Patients with Acute Respiratory Distress Syndrome or Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

“…The benefit of ECCO 2 R is not related only to excess CO 2 removal but also to spare work of breathing in spontaneously breathing COPD patients, to diminish dynamic hyperinflation (which can lead to barotrauma and volutrauma) in IMV COPD patients, and to achieve ultraprotective mechanical ventilation in moderate ARDS patients while diminishing tidal volume to 3-4 mL/kg predicted body weight, diminishing respiratory rate, and increasing positive end-expiratory pressure. The previous studies indicated that ECCO 2 R could significantly reduce carbon dioxide partial pressure (PaCO 2 ) in all treated patients than baseline values, including uncontrolled case series or case reports [1,[18][19][20][21][22][23][24][25][26][27][28]. It has been suggested that ECCO 2 R can avoid the need for IMV in 90% of the patients [29].…”