Lung protective strategy for ventilation in acute lung failure with pECLA (pumpless extracorporal lung assist)

Introduction

The morphological changes in the lungs in acute lung injury (ALI) often lead to high elevated inspiratory pressures and the use of high dosed toxic inspiratory O₂-concentration. This requires an appropriate adaptation of the mechanical ventilation to reduce ventilation associated complications. In our department we use the pumpless extracorporal lung assist (pECLA; Jostra Medizintechnik, Germany) to bridge these ventilation problems till the main lung injuries, which led to the ALI, have been healed.

Methods

In three patients the pECLA-procedure was performed after exhausting all possible ventilation strategies to avoid respirator associated complications. In these patients the femoral vein and artery were cannulated with tubes with diameters between 15 and 19 Fr. Comparable to the continuous arterio-venous dialysis the bloodstream passes a special unit. In this case an oxygenator in which oxygen is inflated with flow of 15 l/min. The high oxygen partial pressure in the oxygenator displaces the carbon dioxide out of its bond to the haemoglobin.

Results

The pECLA-procedure was performed in three patients with a mean age of 55 ± 15 (SD) years. The lung injury score was 3.7 ± 0.4. In two patients the ALI was caused by pneumonia and severe sepsis. In one patient it was caused by a cardiogenic shock. The pECLA-procedure led at the latest after 3 days to lungprotective ventilation (Table). One of the three patients survived and has been discharged from hospital. The two others died. One due to an intracerebral bleeding and the other one due to a prolonged mesenteric ischemia which led to his severe sepsis.

Table

Conclusion

With the usage of the pECLA it seemed to be possible to achieve a lungprotective ventilation also in nearly hopeless cases. To find evidence that morbidity and mortality can be reduced by this approach further trials should be conducted.