Arteriovenous extracorporeal lung assist as integral part of a multimodal treatment concept

Muellenbach, Ralf Michael; Kredel, Markus; Wunder, Christian; Küstermann, J.; Wurmb, Thomas; Schwemmer, Ulrich; Schuster, Frank; Anetseder, Martin; Roewer, Norbert; Brederlau, Joerg

doi:10.1017/s0265021508004870

Cited by 31 publications

(8 citation statements)

References 26 publications

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“…Two studies reported VFDs [18,27]. The primary outcome measure in the Xtravent study was VFDs to 28 and 60 days [19].…”

Section: Reviewmentioning

confidence: 99%

“…Five studies (two RCTs and three retrospective studies) reported ICU length of stay [18,19,26,27,29]. Neither RCT demonstrated a significant reduction in ICU length of stay.…”

Section: Reviewmentioning

confidence: 99%

“…Several studies reported comparative analysis of respiratory parameters between survivors and nonsurvivors of ECCO 2 R [24,27,28], whilst other studies reported measurements at varying time points, from 2 hours after initiation of ECCO 2 R to its discontinuation.…”

Section: Reviewmentioning

confidence: 99%

“…Complication rates ranged from 0 to 25%. Five studies reported rates in excess of 20% [21,27-30]. Amongst studies examining arteriovenous devices, the most common complication was lower limb ischaemia secondary to arterial cannulation.…”

Section: Reviewmentioning

confidence: 99%

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Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

et al. 2014

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Acute respiratory distress syndrome (ARDS) continues to have significant mortality and morbidity. The only intervention proven to reduce mortality is the use of lung-protective mechanical ventilation strategies, although such a strategy may lead to problematic hypercapnia. Extracorporeal carbon dioxide removal (ECCO2R) devices allow uncoupling of ventilation from oxygenation, thereby removing carbon dioxide and facilitating lower tidal volume ventilation. We performed a systematic review to assess efficacy, complication rates, and utility of ECCO2R devices. We included randomised controlled trials (RCTs), case–control studies and case series with 10 or more patients. We searched MEDLINE, Embase, LILACS (Literatura Latino Americana em Ciências da Saúde), and ISI Web of Science, in addition to grey literature and clinical trials registries. Data were independently extracted by two reviewers against predefined criteria and agreement was reached by consensus. Outcomes of interest included mortality, intensive care and hospital lengths of stay, respiratory parameters and complications. The review included 14 studies with 495 patients (two RCTs and 12 observational studies). Arteriovenous ECCO2R was used in seven studies, and venovenous ECCO2R in seven studies. Available evidence suggests no mortality benefit to ECCO2R, although post hoc analysis of data from the most recent RCT showed an improvement in ventilator-free days in more severe ARDS. Organ failure-free days or ICU stay have not been shown to decrease with ECCO2R. Carbon dioxide removal was widely demonstrated as feasible, facilitating the use of lower tidal volume ventilation. Complication rates varied greatly across the included studies, representing technological advances. There was a general paucity of high-quality data and significant variation in both practice and technology used among studies, which confounded analysis. ECCO2R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed.

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“…Two studies reported VFDs [18,27]. The primary outcome measure in the Xtravent study was VFDs to 28 and 60 days [19].…”

Section: Reviewmentioning

confidence: 99%

“…Five studies (two RCTs and three retrospective studies) reported ICU length of stay [18,19,26,27,29]. Neither RCT demonstrated a significant reduction in ICU length of stay.…”

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

et al. 2014

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“…An increased ventilation rate may allow only to compensate in part for the decrease in tidal ventilation resulting in hypercapnic acidosis [4], [7], [9]. There is some evidence from cell culture and animal studies including our own studies using this surfactant depletion model (unpublished data), that hypercapnic acidosis itself induced by administration of carbon dioxide to the inspired air (so called therapeutic hypercapnia) protects the lung [14]–[16] and increases oxygen delivery to the tissues [17].…”

Section: Introductionmentioning

confidence: 95%

Very Low Tidal Volume Ventilation with Associated Hypercapnia - Effects on Lung Injury in a Model for Acute Respiratory Distress Syndrome

et al. 2011

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BackgroundVentilation using low tidal volumes with permission of hypercapnia is recommended to protect the lung in acute respiratory distress syndrome. However, the most lung protective tidal volume in association with hypercapnia is unknown. The aim of this study was to assess the effects of different tidal volumes with associated hypercapnia on lung injury and gas exchange in a model for acute respiratory distress syndrome.Methodology/Principal FindingsIn this randomized controlled experiment sixty-four surfactant-depleted rabbits were exposed to 6 hours of mechanical ventilation with the following targets: Group 1: tidal volume = 8–10 ml/kg/PaCO2 = 40 mm Hg; Group 2: tidal volume = 4–5 ml/kg/PaCO2 = 80 mm Hg; Group 3: tidal volume = 3–4 ml/kg/PaCO2 = 120 mm Hg; Group 4: tidal volume = 2–3 ml/kg/PaCO2 = 160 mm Hg. Decreased wet-dry weight ratios of the lungs, lower histological lung injury scores and higher PaO2 were found in all low tidal volume/hypercapnia groups (group 2, 3, 4) as compared to the group with conventional tidal volume/normocapnia (group 1). The reduction of the tidal volume below 4–5 ml/kg did not enhance lung protection. However, oxygenation and lung protection were maintained at extremely low tidal volumes in association with very severe hypercapnia and no adverse hemodynamic effects were observed with this strategy.ConclusionVentilation with low tidal volumes and associated hypercapnia was lung protective. A tidal volume below 4–5 ml/kg/PaCO2 80 mm Hg with concomitant more severe hypercapnic acidosis did not increase lung protection in this surfactant deficiency model. However, even at extremely low tidal volumes in association with severe hypercapnia lung protection and oxygenation were maintained.

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Support Therapy for Lung Failure

Lynch

Zwischenberger

2010

Difficult Decisions in Thoracic Surgery

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Arteriovenous extracorporeal lung assist as integral part of a multimodal treatment concept

Cited by 31 publications

References 26 publications

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review

Very Low Tidal Volume Ventilation with Associated Hypercapnia - Effects on Lung Injury in a Model for Acute Respiratory Distress Syndrome

Support Therapy for Lung Failure

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