Thoracic transplantation
Lung
The Use of CO2 Removal Devices in Patients Awaiting Lung Transplantation: An Initial Experience

https://doi.org/10.1016/j.transproceed.2010.03.117Get rights and content

Abstract

Background

Lung transplantation is the treatment of choice for patients with end-stage lung failure. Limitations are presented by the shortage of donors and the long waiting list periods. New techniques, such as extracorporeal membrane ventilator devices with or without pump support, have been developed as bridges to transplantation for patients with severe, unresponsive respiratory insufficiency.

Methods

Between November 2005 and September 2009, 12 patients (7 males and 5 females), of overall mean age of 43.3 ± 15.5 years underwent decapneization with extracorporeal devices. In 6 cases, a NovaLung system was used; in the remaining 6 patients, it was a Decap device. Causes of respiratory failure that led to implantation of such devices were cystic fibrosis (n = 6), pulmonary emphysema (n = 5), and chronic rejection of a previous double lung transplant (n = 1).

Results

Mean time on extracorporeal decapneization was 13.5 ± 14.2 days. Eight patients died on the device. Three patients were bridged to lung transplantation; 1 recovered and was weaned from the device after 11 days. Mean PaCO2 on the extracorporeal gas exchanger was significantly lower for both the devices at 24, 48, and 72 hours after implantation (P < .05). No significant difference was observed for the 2 systems.

Conclusion

In our initial experience, decapneization devices have been simple, efficient methods to support patients with mild hypoxia and severe hypercapnia that is refractory to mechanical ventilation. This could represent a valid bridge to lung transplantation in these patients.

Section snippets

Materials and Methods

From November 2005 to September 2009, 12 LT waiting list patients (7 males, 5 females) of overall mean age of 43.3 ± 15.5 years were treated with extracorporeal devices for CO2 removal because of severe ventilation-refractory hypercapnia with respiratory acidosis. In 6 patients, the Decap system was used; the other 6 underwent ILA implantation. The decision on which device was made on the basis of the hemodynamic capability of the patient to sustain extracorporeal gas exchange with or without

Results

All patients except 1 were on mechanical ventilatory support before device implantation. The indication for decapneization device implantation was severe hypercapnia and acidosis refractory to positive high pressure mechanical ventilation. The only subject not on a ventilator was a lung transplant patient treated with ILA because of respiratory failure owing to worsening chronic rejection. This not intubated patient has been on ILA assistance awaiting lung retransplantation. The original lung

Discussion

The aim of insertion of percutaneous extracorporeal lung assistance devices is to allow lung protective ventilation, to improve gas exchange, and at the same time, to reduce the lung damage due to high-pressure–high-volume mechanical ventilation. In this way, native lung function is supported, the diseased lung may better and more quickly recover from acute respiratory failure as artificial ventilation can be downgraded. Our results confirmed the decapneization efficacy of ILA and Decap at 24,

References (12)

There are more references available in the full text version of this article.

Cited by (73)

  • State of the Art: Bridging to lung transplantation using artificial organ support technologies

    2016, Journal of Heart and Lung Transplantation
    Citation Excerpt :

    Finally, from a practical standpoint, it is important to note that because pump-less A-V ECMO is typically cannulated through the femoral vessels, it is most commonly a non-ambulatory strategy. V-V ECCO2R is another promising right-sided approach to LT bridging in patients presenting with predominant impairment in CO2 elimination.80,81 Because CO2 has high blood solubility and is carried as bicarbonate in small blood volumes, blood flow requirements for CO2 removal are far lower than for provision of O2 supply.

  • CASE 7—2016 Choice of Percutaneous Mechanical Assistance During Cardiopulmonary Instability: Heart, Lungs, or Both?

    2016, Journal of Cardiothoracic and Vascular Anesthesia
    Citation Excerpt :

    Advantages of the single-site approach include avoidance of the femoral access site, improved patient mobility, and considerably reduced recirculation when the cannula is positioned properly. Also known as the “artificial lung” or pumpless extracorporeal lung assist (pECLA; Interventional Lung Assist, Novalung, Heilbronn, Germany),16–18 it is used in patients with acute lung injury yet stable hemodynamically. Typically, inflow is femoral artery, and outflow is femoral vein.

  • ICU Care Before and After Lung Transplantation

    2016, Chest
    Citation Excerpt :

    CO2 removal in hypercapnic emphysema patients is used to avoid intubation. More than 60% of COPD patients could be weaned from these devices demonstrating rather a “bridge to recovery” approach in this subgroup.53-55 Patients with acute respiratory failure (eg, ARDS, pneumonia) are generally not considered as suitable candidates for LTx.

View all citing articles on Scopus
View full text