25. Percutaneous Extracorporeal Arteriovenous Carbon Dioxide Removal (AVCO2R) in Adult Patients with Severe Respiratory Failure: Initial Clinical Experience

Joseph B. Zwischenberger, Steven A. Conrad, Scott K. Alpard, Akhil Bidani

University of Texas Medical Branch

Galveston, Texas

In our initial clinical experience of AVCO₂R, five patients were treated for severe respiratory failure and CO₂ retention to evaluate feasibility and safety by percutaneous femoral cannulation (10-12 F arterial and 12-15 F venous), heparinized (ACT 260-300 sec), then connected to a primed, low-resistance, 2.5 m² hollow fiber oxygenator for 72 hours. Mean AVCO₂R flow at 24, 48 and 72 hours was 837.4 ± 73.9 mL/minute, 873 ± 83.6 mL/minute, and 750 ± 104.5 mL/minute, respectively with no vascular complications and no significant change in heart rate or mean arterial pressure. CO₂ removal plateau at AVCO₂R flow of 1086 mL/minute with 208 mL/minute CO₂ removed. Average CO₂ transfer at 24 and 48 hours was 142 ± 17 mL/minute and 129 ± 16 mL/minute. AVCO₂R allowed a significant decrease in minute ventilation (MV) from 7.2 ± 2.3 L/minute at baseline to 3.4 ± 0.8 L/minute at 24 hours. All patients survived the experimental period without adverse sequelae. Percutaneous AVCO₂ can achieve near total CO₂ removal in adults with severe respiratory failure and CO₂ retention without hemodynamic compromise or instability.