Evaluation of a New Extracorporeal CO(2) Removal Device in an Experimental Setting

Background: Ultra-protective lung ventilation in acute respiratory distress syndrome or early weaning and/or avoidance of mechanical ventilation in decompensated chronic obstructive pulmonary disease may be facilitated by the use of extracorporeal CO(2) removal (ECCO(2)R). We tested the CO(2) removal performance of a new ECCO(2)R (CO(2)RESET) device in an experimental animal model. Methods: Three healthy pigs were mechanically ventilated and connected to the CO(2)RESET device (surface area = 1.8 m(2), EUROSETS S.r.l., Medolla, Italy). Respiratory settings were adjusted to induce respiratory acidosis with the adjunct of an external source of pure CO(2) (target pre membrane lung venous PCO(2) (P(pre)CO(2)): 80–120 mmHg). The amount of CO(2) removed (VCO(2), mL/min) by the membrane lung was assessed directly by the ECCO(2)R device. Results: Before the initiation of ECCO(2)R, the median P(pre)CO(2) was 102.50 (95.30–118.20) mmHg. Using fixed incremental steps of the sweep gas flow and maintaining a fixed blood flow of 600 mL/min, VCO(2) progressively increased from 0 mL/min (gas flow of 0 mL/min) to 170.00 (160.00–200.00) mL/min at a gas flow of 10 L/min. In particular, a high increase of VCO(2) was observed increasing the gas flow from 0 to 2 L/min, then, VCO(2) tended to progressively achieve a steady-state for higher gas flows. No animal or pump complications were observed. Conclusions: Medium-flow ECCO(2)R devices with a blood flow of 600 mL/min and a high surface membrane lung (1.8 m(2)) provided a high VCO(2) using moderate sweep gas flows (i.e., >2 L/min) in an experimental swine models with healthy lungs.