Percutaneous extracorporeal arteriovenous CO₂ removal for severe respiratory failure

Background. In previous animal studies, arteriovenous CO₂ removal (AVCO₂R) achieved significant reduction in ventilator pressures and improvement in the PaO₂ to fraction of inspired oxygen ratio during severe respiratory failure. For our initial clinical experience, 5 patients were approved for treatment of severe respiratory failure and CO₂ retention to evaluate the feasibility and safety of percutaneous AVCO₂R.Methods. Patients were anticoagulated with heparin (activated clotting time, 260 to 300 seconds), underwent percutaneous femoral cannulation (10F to 12F arterial and 12F to 15F venous catheters), and then were connected to a low-resistance, 2.5-m² hollow-fiber oxygenator for 72 hours.Results. Mean AVCO₂R flow at 24, 48, and 72 hours was 837.4 ± 73.9, 873 ± 83.6, and 750 ± 104.5 mL/min, respectively, with no vascular complications and no significant change in heart rate or mean arterial pressure. Removal of CO₂ plateaued at an AVCO₂R flow of 1086 mL/min with 208 mL/min CO₂ removed. Average CO₂ transfer at 24 and 48 hours was 142 ± 17 and 129 ± 16 mL/min. Use of AVCO₂R allowed a significant decrease in minute ventilation from 7.2 ± 2.3 L/min at baseline to 3.4 ± 0.8 L/min at 24 hours.Conclusions. All patients survived the experimental period without adverse sequelae. Percutaneous AVCO₂R can achieve approximately 70% CO₂ removal in adults with severe respiratory failure and CO₂ retention without hemodynamic compromise or instability. Copyright (C) 1999 The Society of Thoracic Surgeons.