Introducing the Homburg lung: Efficacy and safety of a minimal-invasive system for extracorporeal CO<sub>2</sub>removal

Seiler, Frederik; Trudzinski, Franziska; Kamp, A; Τσίτουρας, Κωνσταντίνος; Linn, Oliver; Metz, Carlos; Böhmer, Philip; Kaiser, Ralf; Fähndrich, Sebastian; Wilkens, Heinrike; Haake, Hendrik; Bals, Robert; Lepper, Philipp M.

doi:10.1183/13993003.congress-2016.pa3571

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“…While animal-based ECMO or ECCO 2 R test setups remain gold standard, for certain scientific issues, the animal model might not add additional benefit despite being a lot more complex and costlier. The test circuit in this model was inspired by the Homburg lung, the most commonly used ECCO 2 R platform in our center, which is based on the Rotaflow platform and a pediatric Quadrox iD oxygenator [ 11 ]. One advantage of our mock setup in comparison to animal-based ECCO 2 R experiments is the ability to modify blood gas parameters and the hemoglobin level more easily.…”

Section: Discussionmentioning

confidence: 99%

A mock circulation loop to test extracorporeal CO2 elimination setups

Schwärzel

Jungmann

Schmoll

et al. 2020

ICMx

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Background Extracorporeal carbon dioxide removal (ECCO2R) is a promising yet limited researched therapy for hypercapnic respiratory failure in acute respiratory distress syndrome and exacerbated chronic obstructive pulmonary disease. Herein, we describe a new mock circuit that enables experimental ECCO2R research without animal models. In a second step, we use this model to investigate three experimental scenarios of ECCO2R: (I) the influence of hemoglobin concentration on CO2 removal. (II) a potentially portable ECCO2R that uses air instead of oxygen, (III) a low-flow ECCO2R that achieves effective CO2 clearance by recirculation and acidification of the limited blood volume of a small dual lumen cannula (such as a dialysis catheter). Results With the presented ECCO2R mock, CO2 removal rates comparable to previous studies were obtained. The mock works with either fresh porcine blood or diluted expired human packed red blood cells. However, fresh porcine blood was preferred because of better handling and availability. In the second step of this work, hemoglobin concentration was identified as an important factor for CO2 removal. In the second scenario, an air-driven ECCO2R setup showed only a slightly lower CO2 wash-out than the same setup with pure oxygen as sweep gas. In the last scenario, the low-flow ECCO2R, the blood flow at the test membrane lung was successfully raised with a recirculation channel without the need to increase cannula flow. Low recirculation ratios resulted in increased efficiency, while high recirculation ratios caused slightly reduced CO2 removal rates. Acidification of the CO2 depleted blood in the recirculation channel caused an increase in CO2 removal rate. Conclusions We demonstrate a simple and cost effective, yet powerful, “in-vitro” ECCO2R model that can be used as an alternative to animal experiments for many research scenarios. Moreover, in our approach parameters such as hemoglobin level can be modified more easily than in animal models.

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Section: Discussionmentioning

confidence: 99%