Jeffries R Garrett, Lund Laura, Frankowski Brian, Federspiel William J
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
McGowan Institute for Regenerative Medicine, University of Pittsburgh, 3025 E Carson St, Suite 226, Pittsburgh, PA, 15203, USA.
Intensive Care Med Exp. 2017 Sep 6;5(1):41. doi: 10.1186/s40635-017-0154-1.
Extracorporeal carbon dioxide removal (ECCOR) systems have gained clinical appeal as supplemental therapy in the treatment of acute and chronic respiratory injuries with low tidal volume or non-invasive ventilation. We have developed an ultra-low-flow ECCOR device (ULFED) capable of operating at blood flows comparable to renal hemodialysis (250 mL/min). Comparable operating conditions allow use of minimally invasive dialysis cannulation strategies with potential for direct integration to existing dialysis circuitry.
A carbon dioxide (CO) removal device was fabricated with rotating impellers inside an annular hollow fiber membrane bundle to disrupt blood flow patterns and enhance gas exchange. In vitro gas exchange and hemolysis testing was conducted at hemodialysis blood flows (250 mL/min).
In vitro carbon dioxide removal rates up to 75 mL/min were achieved in blood at normocapnia (pCO = 45 mmHg). In vitro hemolysis (including cannula and blood pump) was comparable to a Medtronic Minimax oxygenator control loop using a time-of-therapy normalized index of hemolysis (0.19 ± 0.04 g/100 min versus 0.12 ± 0.01 g/100 min, p = 0.169).
In vitro performance suggests a new ultra-low-flow extracorporeal CO removal device could be utilized for safe and effective CO removal at hemodialysis flow rates using simplified and minimally invasive connection strategies.
体外二氧化碳清除（ECCOR）系统作为补充疗法，在治疗采用低潮气量或无创通气的急慢性呼吸损伤方面已获得临床认可。我们开发了一种超低流量ECCOR装置（ULFED），其能够在与肾血液透析相当的血流速度（250毫升/分钟）下运行。相似的运行条件允许使用微创透析插管策略，有可能直接整合到现有的透析回路中。
制作了一种二氧化碳（CO）清除装置，在环形中空纤维膜束内设置旋转叶轮，以扰乱血流模式并增强气体交换。在血液透析血流速度（250毫升/分钟）下进行体外气体交换和溶血测试。
在正常碳酸血症（pCO = 45 mmHg）的血液中，体外二氧化碳清除率高达75毫升/分钟。使用治疗时间标准化溶血指数，体外溶血（包括插管和血泵）与美敦力Minimax氧合器控制回路相当（0.19±0.04克/100分钟对0.12±0.01克/100分钟，p = 0.169）。
体外性能表明，一种新型超低流量体外CO清除装置可利用简化和微创连接策略，在血液透析流速下安全有效地清除CO。
