Significant enhancement of carbon dioxide removal by a new prototype IVOX.

The intravenacaval blood gas exchanger (IVOX) developed by Cardiopulmonics, Inc. has been tested in animals and in human clinical trials for partial support of gas exchange (25-30%) to allow reduction in mechanical ventilatory support and barotrauma during acute respiratory failure. After recognizing the limitations of the device and limited clinical utility of removing only 25-30% of CO2 production, the authors have made design changes in the IVOX (prototypes IIA and IIB), including increased fiber number, decreased fiber length, decreased fiber diameter, and increased crimping. Nine ewes underwent placement of the IVOX prototypes in an ovine model of severe smoke inhalation injury. A modification of the original insertion technique was used to implant the prototypes. CO2 removal was directly measured from the outlet gas. O2 exchange was calculated from IVOX on/off measurements. Neither IVOX IIA nor IIB significantly changed hemodynamics when a fluid bolus (15 ml/kg) was infused before insertion. There were no significant differences between prototypes regarding thrombosis, emboli, or incidence of bleeding complications. Both prototypes significantly improved CO2 removal (60-80%) compared with that reported for an older IVOX model. The improved gas transfer by these prototypes would serve to decrease mechanical ventilatory requirements and barotrauma in the treatment of severe respiratory failure.