A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal

Hermann, Alexander; Riss, Katharina; Schellongowski, Peter; Bojic, Andja; Wohlfarth, Philipp; Robak, Oliver; Sperr, Wolfgang R.; Staudinger, Thomas

doi:10.1007/s00134-015-3957-0

Cited by 39 publications

(42 citation statements)

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“…We used the iLA Activve (Xenios, Heilbronn, Germany) or the Cardiohelp system (Maquet, Rastatt, Germany) for ECMO therapy. Both systems have been well described for venovenous extracorporeal gas exchange . Cannulation was performed either using a bicaval double‐lumen cannula (Avalon ELITE, Maquet), a unicaval double‐lumen cannula (Novaport twin, Xenios), or a two‐cannula setting with separate drainage and a reperfusion cannulas (HLS, Maquet).…”

Section: Methodsmentioning

confidence: 99%

“…Both systems have been well described for venovenous extracorporeal gas exchange. [12][13][14][15][16] Cannulation was performed either using a bicaval double-lumen cannula (Avalon ELITE, Maquet), a unicaval double-lumen cannula (Novaport twin, Xenios), or a two-cannula setting with separate drainage and a reperfusion cannulas (HLS, Maquet). We used Seldinger's technique 17 for percutaneous cannula insertion controlled by ultrasound guidance.…”

Section: Methodsmentioning

confidence: 99%

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ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

et al. 2019

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Severe thrombocytopenia poses a high risk for bleeding thus representing a relative contraindication for anticoagulation and therefore extracorporeal membrane oxygenation (ECMO). We herein report on a series of immunocompromised patients with severe thrombocytopenia undergoing long‐term ECMO without systemic anticoagulation. We retrospectively identified seven adult patients with anticoagulation withdrawal for ≥3 days (range 5–317) during venovenous ECMO therapy due to thrombocytopenia < 50 G/L treated in a university‐affiliated hospital from January 2013 to April 2017. All ECMO systems used were heparin coated. Overall, 530 ECMO days were observed, 404 (76%) of them without systemic anticoagulation. Platelet count during ECMO treatment was 24 G/L (median, range 1‐138), ECMO duration was 35 days (5‐317), and ECMO was run without any anticoagulation for 20 days (5‐317). Altogether, five clotting events were seen leading to oxygenator exchanges. Bleeding was common including one fatal intracerebral hemorrhage. Altogether, 29 platelet concentrates per patient (7‐207) were administered, which correspond to 0.8 per day (0.6‐1.3). One patient survived ICU and hospital. In patients with thrombocytopenia, ECMO can be run without anticoagulation even for considerably long periods of time. Bleeding remains common, while clotting events seem to be rare. However, prognosis of this patient population undergoing ECMO support seems grim.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

et al. 2019

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“…Im niedrigen Blutflussbereich <1000 ml/min ist der Oxygenierungseffekt gering, die CO2-Elimination nimmt jedoch mit steigendem Blutfluss rasch zu und steigt bis zu einem Volumen von 1500-2000 ml/min noch weiter an. In diesem Flussbereich ist ebenfalls mit einem klinisch relevanten Oxygenierungseffekt zu rechnen [17]. Im Einzelfall mag dies den Gasaustausch über die Lunge teilweise ersetzen.…”

Section: Abb 1 8 Schematische Darstellung Von Co2-elimination Und Saunclassified

Extrakorporale Membranoxygenierung

Staudinger

2017

Med Klin Intensivmed Notfmed

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“…The aims of ECCO 2 -R are: (1) the management of acute 'isolated' hypercapnic respiratory failure, (2) the reduction of tidal volume (3-4 ml/kg) and the control of hypercapnia, and (3) the avoidance of intubation in exacerbated chronic obstructive lung disease. While in the latter situation a number of small observational studies or case reports exerted promising results, the scientific evidence for the use and benefit of ECCO 2 -R in ARDS patients is limited [2].The prospective observational study by Hermann et al [3], investigating the efficacy and safety of a novel pumpdriven ECCO2-R-system demonstrated a significant, but 'intensity'-dependent, amount of CO 2 removal between 40 and 70 ml/min. The CO 2 transfer was dependent on the amount of blood flow (0.5-2.0 l/min) and sweep gas flow.…”

mentioning

confidence: 99%

“…The prospective observational study by Hermann et al [3], investigating the efficacy and safety of a novel pumpdriven ECCO2-R-system demonstrated a significant, but 'intensity'-dependent, amount of CO 2 removal between 40 and 70 ml/min. The CO 2 transfer was dependent on the amount of blood flow (0.5-2.0 l/min) and sweep gas flow.…”

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confidence: 99%

Focus on ECMO and ECCO2R in ARDS patients

Bein

Aubron²,

Papazian

2017

Intensive Care Med

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The technical aspects of veno-venous extracorporeal membrane oxygenation (vv-ECMO) are still improving, permitting the treatment of ARDS patients with very severe hypoxaemia. A recent German survey showed that the incidence of vv-ECMO in the population increased from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and then stabilised at 2.4:100,000 in 2014 [1]. The in-hospital mortality slightly decreased over time but remained high, at 58.1% in 2014. This real-life mortality rates in an unselected population of patients undergoing ECMO for ARDS is even higher than previously reported. The extracorporeal CO 2 -removal (ECCO 2 -R) is a modification of ECMO characterised by a reduction in extracorporeal blood and sweep gas flow. The aims of ECCO 2 -R are: (1) the management of acute 'isolated' hypercapnic respiratory failure, (2) the reduction of tidal volume (3-4 ml/kg) and the control of hypercapnia, and (3) the avoidance of intubation in exacerbated chronic obstructive lung disease. While in the latter situation a number of small observational studies or case reports exerted promising results, the scientific evidence for the use and benefit of ECCO 2 -R in ARDS patients is limited [2].The prospective observational study by Hermann et al. [3], investigating the efficacy and safety of a novel pumpdriven ECCO2-R-system demonstrated a significant, but 'intensity'-dependent, amount of CO 2 removal between 40 and 70 ml/min. The CO 2 transfer was dependent on the amount of blood flow (0.5-2.0 l/min) and sweep gas flow. A rapid normalisation of hypercapnia secondary to higher blood flows (>1.0 l/min) and a moderate increase in oxygenation were found. However, very high sweep gas flows (higher than 10 l/min) were associated with a deterioration in O 2 and CO 2 transfer. Based on these study results, it is recommended to use ECCO 2 -R settings that combine moderate blood flow (1-1.5 l/min) and sweep gas flow (2-8 l/min) to achieve the best clinical effect and to avoid adverse effects. The combination of ECCO 2 -R and renal replacement therapy was investigated in 11 patients with ARDS and acute renal failure [4]. A membrane oxygenator was inserted in a continuous RRT system, resulting in an average CO 2 removal rate of 80 ml/ min (corresponds to a reduction of ≈20% of the arterial PaCO 2 level). Consequently, the tidal volume was lowered from 6 to 4 ml/kg and the plateau pressure could be reduced from 25 to 21 cm H 2 O (p < 0.01); no adverse events were reported. It is concluded that the combination of ECCO 2 -R with renal replacement therapy allows a safe and adequate blood 'purification' of renal-and pulmonary-associated substances together while enhancing lung protective ventilation in critically ill patients. The trend towards a 'personalised medicine' has reached intensive care medicine and the management of ARDS patients should be revisited accordingly [5]. ECCO 2 -R could become an important part of such a project in a 'balanced' portfolio of extracorporeal lung support. Although vv-ECMO r...

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A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal

Abstract: Increasing sweep gas flow results in effective CO2-removal, which can be further reinforced by raising blood flow. The clinically relevant oxygenation effect in this setting could broaden the range of indications of the system and help to set up an individually tailored configuration.

Cited by 39 publications

References 19 publications

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

Extrakorporale Membranoxygenierung

Focus on ECMO and ECCO2R in ARDS patients

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