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ECCO2 removal with a phosphorylcholine-coated membrane oxygenator in difficult respiratory weaning patients

Introduction

ECCO2 removal may be a useful support in patients with difficult respiratory weaning. The aim of this study is to evaluate a new phosphorylcholine-coated EECO2 removal system with no thrombogenic activity to assess the clinical safety of the system, the changes of main cardiorespiratory indices and CO2 removal by the system.

Methods

Ten patients were enrolled. Before starting with ECCO2 removal all patients were ventilated with TV <6 ml/kg, peak pressure >35 cmH2O and pH <7.25. ECCO2 removal was initiated using a modified continuous venovenous hemofiltration system with a membrane oxygenator (ABYLCAP; Bellco, Mirandola, Italy; membrane surface area: 0.67 m2, blood flow 280 to 350 ml/minute, phosphorylcholine coated). Femoral vein cannulation with a double-lumen catheter was used to connect the patients to the extracorporeal system. Heparin was infused to maintain ACT <190 to 240 seconds. All patients had ECCO2 for 4 days. Every 12 hours the pH, PaCO2, peak pressure and PaO2 were evaluated. VCO2 was determined by indirect calorimetry using a gas analyser equipped on an Engstrom Carestation Ventilator. During the ECCO2 removal the patients were ventilated with TV ≤6 ml/kg and peak pressure <30 cmH2O. All data are expressed as mean ± SD. One-way ANOVA was used to compare the changes of parameters. P < 0.05 was considered significant.

Results

Table 1 presents the main results. The CO2 removal by membrane oxygenator ranged from 56 to 37 ml/minute. All patients survived to the treatment and 7/10 were weaned from the ventilator at the end of ECCO2 removal. Only one oxygenator was used for every patient without clotting of the circuit or any major bleeding problem.

Table 1 (abstract P129)

Conclusion

ECCO2 removal with a phosphorylcholine-coated membrane oxygenator is clinically safe, avoids clotting of the oxygenator circuit and allows adequate CO2 removal.

References

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Correspondence to F Turani.

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Turani, F., Martini, S., Marinelli, A. et al. ECCO2 removal with a phosphorylcholine-coated membrane oxygenator in difficult respiratory weaning patients. Crit Care 17, P129 (2013). https://doi.org/10.1186/cc12067

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Keywords

  • Heparin
  • Femoral Vein
  • Peak Pressure
  • Indirect Calorimetry
  • Clinical Safety