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      Physiological and Technical Considerations of Extracorporeal CO2 Removal.

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          Abstract

          This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

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          A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.

          L Hagmeyer, Shawn Becker, F Bonin … (2013)
          Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients. This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean. The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization. This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure.
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            Estimation of shear stress-related blood damage in heart valve prostheses--in vitro comparison of 25 aortic valves.

            R Opitz, Johannes M. H. M. Reul, L Wurzinger … (1990)
            The hemodynamics of heart valve prostheses can be reproducibly investigated in vitro within circulatory mock loops. By measuring the downstream velocity and shear stress fields the shear stresses which are clinically responsible for damage to platelets and red blood cells can be determined. The mechanisms of damage and the effects of shear stresses on blood corpuscles were investigated by Wurzinger et al. at the Aerodynamics Institute of the RWTH Aachen. In the present study, the above data are incorporated into a mathematical correlation, which serves as a basic model for the estimation of blood damage. This mathematical model was applied to in vitro investigations of 25 different aortic valve prostheses. The results were compared to clinical findings. In most cases agreement was good, indicating that this model may be directly applied to the clinical situation. This new method facilitates the estimation of clinically expected blood damage from in vitro measurements. It may be useful for the development and evaluation of new valve prostheses. By comparative evaluation of different valve types it also provides additional information to help the implanting surgeon select the optimum valve for his patient.
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              Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control.

              Lorenzo Del Sorbo, Lara Pisani, Claudia Filippini … (2015)
              To assess efficacy and safety of noninvasive ventilation-plus-extracorporeal Co2 removal in comparison to noninvasive ventilation-only to prevent endotracheal intubation patients with acute hypercapnic respiratory failure at risk of failing noninvasive ventilation.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Crit Care
                Title: Critical care (London, England)
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1466-609X
                ISSN (Print): 1364-8535
                Publication date (Electronic): Mar 09 2019
                Volume: 23
                Issue: 1
                Affiliations
                [1 ] Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, D-51109, Cologne, Germany. Christian.Karagiannidis@uni-wh.de.
                [2 ] Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute Aachen, RWTH Aachen University, Aachen, Germany.
                [3 ] Interdepartmental Division of Critical Care Medicine, University of Toronto and the Extracorporeal Life Support Program, Toronto General Hospital, Toronto, Canada.
                Article
                Publisher Item ID: 10.1186/s13054-019-2367-z
                DOI: 10.1186/s13054-019-2367-z
                PMC ID: 6408850
                PubMed ID: 30849995
                SO-VID: 634f4380-c7a1-4428-ab2f-2d7d9ae1ec12
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