title: Arterio-venous CO2 removal (AVCO2R) perioperative management: rapid recovery and enhanced survival.
abstract: Percutaneous arteriovenous CO2 removal (AVCO2R) uses a simple arteriovenous (A-V) shunt for near-total CO2 removal that allows significant reductions in minute ventilation. We critically reviewed our algorithm-directed perioperative anesthesia management in our LD40 ovine smoke-burn injury model of acute respiratory distress syndrome (ARDS) treated with AVCO2R. General anesthesia is required for: (1) Vascular access followed by ARDS model development by smoke insufflation (36 breaths) plus 40% TBSA III degrees burn with mechanical ventilation. Induction: 12.5 mg/kg im ketamine and 4% halothane by mask, then intubation. Maintenance: 1.0-2.5% halothane in 100% O2; (2) When PaO2/FiO2 < 200 (48-52 h), sheep randomized to the AVCO2R (n = 8) or SHAM (n = 8) procedure. Induction: 66% N2O and 5% isoflurane in balance O2. Maintenance: 1.5-2.5% isoflurane in 100% O2 for AVCO2R, cannulation (10F carotid artery, 14F jugular vein); (3) Postop, both groups had algorithm-directed ventilator management, identical heparin (ACT > 300 s), fluid, and analgesia management. All sheep met criteria for ARDS, survived anesthesia, and were standing by 0.5-5 h. There were no complications attributable to anesthesia. The absence of anesthesia-related complications allows model development for outcomes studies for ARDS in general and AVCO2R specifically.
authors.affiliation: Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston 77555-0528, USA. jzwische@utmb.edu
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Zwischenberger
authors.forename: Clare
authors.initials: C
authors.lastname: Savage
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Witt
authors.forename: Scott K
authors.initials: SK
authors.lastname: Alpard
authors.forename: Donald D
authors.initials: DD
authors.lastname: Harper
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Deyo
mesh_terms: D000465:Algorithms; D000768:Anesthesia, General / Q000379:methods; D000818:Animals; D001166:Arteriovenous Shunt, Surgical; D002059:Burns, Inhalation / Q000628:therapy; D002245:Carbon Dioxide / Q000097:blood*; D004195:Disease Models, Animal; D019990:Perioperative Care; D011897:Random Allocation; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012756:Sheep
chemical_list: D002245:Carbon Dioxide