Prolonged hemodynamic stability during arteriovenous carbon dioxide removal for severe respiratory failure

Brunston, Robert L.; Tao, Weike; Bidani, A.; Alpard, Scott K.; Traber, Daniel L.; Zwischenberger, Joseph B.

doi:10.1016/s0022-5223(97)70026-6

Cited by 31 publications

(19 citation statements)

References 30 publications

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“…Our data confirmed, despite a 20% to 26% cardiac shunt, that AVCO 2 R can be used for total CO 2 removal for up to 7 days, without hemodynamic compromise or instability, in an adult sheep model of severe respiratory failure. 60 A 10F arterial and 12F venous percutaneous cannula will allow an arteriovenous shunt flow Ͼ500 ml/min and provides some lung rest with permissive hypercapnia. 57 Brunston et al 59 reported that a normal pCO 2 could be maintained with minimal ventilator support at blood flows of 500 ml/min or more.…”

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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“…There was sufficient hemodynamic stability to ensure a pressure gradient between the arterial and venous vasculature. (2) In addition to improved gas exchange and CO 2 removal, the radiological progression was satisfactory. Regarding gas exchange, the major benefit of iLA is CO 2 removal, with little effect on oxygenation.…”

Section: Letter To the Editormentioning

confidence: 86%

“…Hypercapnia can be treated with extracorporeal membrane oxygenation (ECMO), which requires a complex apparatus and is associated with side effects, the use of ECMO being therefore limited to referral centers. In contrast with ECMO, interventional lung assist (iLA), which promotes gas exchange for CO 2 removal without the use of a pump, is carried out via an artificial shunt, which is placed by means of arterial and venous dissection. The use of iLA is indicated for the control of respiratory acidosis and hypoxemia caused by high CO 2 levels (> 80 mmHg) during protective ventilation.…”

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confidence: 99%

“…Because iLA is a recent method, its use has been the subject of several case reports and case series. (2,3) Here, we report two cases of patients who underwent iLA (Novalung GmbH, Talheim, Germany).…”

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confidence: 99%

“…After 14 h on iLA, the patient was started on airway pressure release ventilation and pressure support ventilation, the lung opening pressure being maintained at 15 cmH 2 O. After 48 h on iLA, the patient had a spontaneous delivery and, consequently, the IAP decreased 2 O for 2 min, were unsuccessful. On post-admission day 3, the patient underwent lung biopsy.…”

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Relato de dois casos de pacientes com SARA tratados com membrana extracorpórea de troca gasosa sem bomba

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Extracorporeal Membrane Oxygenation

Conrad

Scott

2006

Wiley Encyclopedia of Biomedical Engineering

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Extracorporeal membrane oxygenation (ECMO) is the provision of long‐term support for severe, potentially reversible cardiopulmonary failure through the use of extrathoracic cannulation and an extracorporeal circuit. The extracorporeal circuit is a modification of the heart‐lung machine used in cardiac bypass surgery and consists of a drainage reservoir, blood pump, artificial lung for oxygen and carbon dioxide exchange, a heat exchanger for maintenance of body temperature, cannulae for vascular access, and connecting tubing. ECMO is used in the management of severe, acute, potentially reversible cardiopulmonary failure in neonates, children, and adults. The modes of support include venoarterial (VA), venovenous (VV), arteriovenous (AV), and hybrid VA and VV (VVA). Venoarterial support bypasses the heart and lungs and provides cardiac and pulmonary support. Venovenous provides gas exchange in the central venous circulation, and it provides pulmonary support only. Arteriovenous is performed using an artificial lung without a pump, but provides carbon dioxide removal only. VVA mode combines partial cardiac support in addition to pulmonary support. The performance of the ECMO circuit depends on several factors. Blood flow is dependent on geometry of the vascular cannulae, tubing, and artificial lung, and it includes laminar and turbulent flow. Pressure‐flow relationships for ECMO circuit components have been published. Gas exchange efficiency in venovenous ECMO is affected by recirculation. The determinants of artificial lung gas transfer are complex but based on principles of passive diffusion. Modern cross‐flow hollow fiber devices that have blood flow exterior to the fibers demonstrate the best blood flow and gas transfer performance.

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Prolonged hemodynamic stability during arteriovenous carbon dioxide removal for severe respiratory failure

Abstract: Arteriovenous carbon dioxide removal as a simplified means of extracorporeal gas exchange support is relatively safe without adverse hemodynamic effects or complications.

Cited by 31 publications

References 30 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

Relato de dois casos de pacientes com SARA tratados com membrana extracorpórea de troca gasosa sem bomba

Extracorporeal Membrane Oxygenation

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