Low-Frequency Positive Pressure Ventilation with Extracorporeal Carbon Dioxide Removal (LFPPV-ECCO2R)

Gattinoni, Luciano; Kolobow, Theodor; Tomlinson, T.; Iapichino, G.; Samaja, Michele; White, DE; Pierce, Joseph E.

doi:10.1213/00000539-197807000-00018

Cited by 139 publications

(73 citation statements)

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“…Targeting CO 2 removal, Gattinoni, together with Kolobow, developed the venovenous extracorporeal CO 2 removal technique (ECCO 2 R) in animals 16,46,47 and for clinical application. 48,49 They 50 reported that low-frequency ventilation, combined with ECCO 2 R, provided sufficient gas exchange and improved survival in animals and patients with ARDS.…”

Section: Discussionmentioning

confidence: 99%

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Alpard¹,

Zwischenberger²,

Tao³

et al. 1999

Annals of Surgery

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ObjectiveTo evaluate the effect of percutaneous arteriovenous carbon dioxide removal (AVCO 2 R) on ventilator pressures and P/F ratio in a clinically relevant large-animal model of severe respiratory failure. Summary Background DataAVCO 2 R was developed as a simple arteriovenous shunt with a commercially available low-resistance gas exchange device of sufficient surface area for near-total CO 2 removal. With an AV shunt 10% to 15% of cardiac output, AVCO 2 R allows a reduction in ventilator airway pressures without hypercapnia or the complex circuitry and monitoring required for conventional ECMO. MethodsAVCO 2 R was applied to a new, clinically relevant large-animal model of severe respiratory failure created by smoke inhalation and cutaneous flame burn injury. Adult sheep (n ϭ 9, 38 Ϯ 6 kg) received a 40% total body surface area, third-degree cutaneous flame burn and 36 breaths of cotton smoke insufflation. After injury, all animals were placed on volumecontrolled mechanical ventilation to achieve PaO 2 Ͼ 60 mmHg and PaCO 2 Ͻ 40 mmHg. Animals were placed on AVCO 2 R within 40 to 48 hours of injury when the PaO 2 /FiO 2 was Ͻ200. Animals underwent cannulation of the carotid artery and jugular vein with percutaneous 10F arterial and 14F venous cannulas. Shunt flow was continuously monitored using an ultrasonic flow probe and calculated as a percentage of cardiac output. ResultsAVCO 2 R flows of 800 to 900 ml/min (11% to 13% cardiac output) achieved 77 to 104 ml/min of CO 2 removal (95% to 97% total CO 2 production) while maintaining normocapnia. Significant reductions in ventilator settings were tidal volume, 421.3 Ϯ 39.8 to 270.0 Ϯ 6.3 ml; peak inspiratory pressure, 24.8 Ϯ 2.4 to 13.7 Ϯ 0.7 cm H 2 O; minute ventilation, 12.7 Ϯ 1.4 to 6.2 Ϯ 0.8 L/min; respiratory rate, 25.4 Ϯ 1.3 to 18.4 Ϯ 1.8 breaths/min; and FiO 2 , 0.88 Ϯ 0.1 to 0.39 Ϯ 0.1. The P/F ratio increased from 151.5 Ϯ 40.0 at baseline to 320.0 Ϯ 17.8 after 72 hours. ConclusionsPercutaneous AVCO 2 R allows near-total CO 2 removal and significant reductions in ventilator pressures with improvement in the P/F ratio.

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Section: Discussionmentioning

confidence: 99%

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Alpard¹,

Zwischenberger²,

Tao³

et al. 1999

Annals of Surgery

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“…In a series of animal experiments in the 1970s, Kolobow et al [21] and Gattinoni et al [22] showed that the use of CO 2 membrane lung for concurrent extracorporeal removal of CO 2 allowed low-frequency positive-pressure ventilation or apneic oxygenation (LFPPV-ECCO2R). The pioneering work on the treatment of patients with refractory ARDS using LFPPV-ECCO2R was published in 1980 by Gattinoni et al [23].…”

Section: Historical Perspective Of Ecco2rmentioning

confidence: 99%

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

Kaushik

Wojewódzka-Żelezniakowicz

Cruz

et al. 2012

Blood Purif

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Extracorporeal organ support in patients with dysfunction of vital organs like the kidney, heart, and liver has proven helpful in bridging the patients to recovery or more definitive therapy. Mechanical ventilation in patients with respiratory failure, although indispensable, has been associated with worsening injury to the lungs, termed ventilator-induced lung injury. Application of lung-protective ventilation strategies are limited by inevitable hypercapnia and hypercapnic acidosis. Various alternative extracorporeal strategies, proposed more than 30 years ago, to combat hypercapnia are now more readily available. In particular, the venovenous approach to effective carbon dioxide removal, which involves minimal invasiveness comparable to renal replacement therapy, appears to be very promising. The clinical applications of these extracorporeal carbon dioxide removal therapies may extend beyond just lung protection in ventilated patients. This article summarizes the rationale, technology and clinical application of various extracorporeal lung assist techniques available for clinical use, and some of the future perspectives in the field.

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“…Gattinoni and colleagues, recognizing that mechanical ventilation was destructive to the injured lung, developed an animal model for extracorporeal carbon dioxide removal, using the native lungs for oxygenation, with minimal inflation pressures. 50 A landmark paper published by the Milan group demonstrated a 49% survival rate in adult patients with selection criteria similar to those used in the NIH trial (in which the survival rate was 10%). 51 Similar successes were published by groups in Marburg, Dusseldorf, Toronto and elsewhere.…”

Section: O N O T D I S T R I B U T Ementioning

confidence: 99%

The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure

Custer

2011

Organogenesis

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Low-Frequency Positive Pressure Ventilation with Extracorporeal Carbon Dioxide Removal (LFPPV-ECCO2R)

Cited by 139 publications

References 0 publications

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Reduced Ventilator Pressure and Improved P/F Ratio During Percutaneous Arteriovenous Carbon Dioxide Removal for Severe Respiratory Failure

Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History

The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure

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