The use of CO2 removal devices in patients awaiting lung transplantation: an initial experience.
BACKGROUND
Lung transplantation is the treatment of choice for patients with end-stage lung failure. Limitations are presented by the shortage of donors and the long waiting list periods. New techniques, such as extracorporeal membrane ventilator devices with or without pump support, have been developed as bridges to transplantation for patients with severe, unresponsive respiratory insufficiency.


METHODS
Between November 2005 and September 2009, 12 patients (7 males and 5 females), of overall mean age of 43.3 +/- 15.5 years underwent decapneization with extracorporeal devices. In 6 cases, a NovaLung system was used; in the remaining 6 patients, it was a Decap device. Causes of respiratory failure that led to implantation of such devices were cystic fibrosis (n = 6), pulmonary emphysema (n = 5), and chronic rejection of a previous double lung transplant (n = 1).


RESULTS
Mean time on extracorporeal decapneization was 13.5 +/- 14.2 days. Eight patients died on the device. Three patients were bridged to lung transplantation; 1 recovered and was weaned from the device after 11 days. Mean PaCO(2) on the extracorporeal gas exchanger was significantly lower for both the devices at 24, 48, and 72 hours after implantation (P < .05). No significant difference was observed for the 2 systems.


CONCLUSIONS
In our initial experience, decapneization devices have been simple, efficient methods to support patients with mild hypoxia and severe hypercapnia that is refractory to mechanical ventilation. This could represent a valid bridge to lung transplantation in these patients.
Division of Cardiac Surgery, San Giovanni Battista Hospital Molinette, University of Torino, Torino, Italy.
D
D
Ricci
M
M
Boffini
L
L
Del Sorbo
S
S
El Qarra
C
C
Comoglio
M
M
Ribezzo
R
R
Bonato
V M
VM
Ranieri
M
M
Rinaldi
D000328:Adult; D001187:Artificial Organs; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000302:isolation & purification*; D002423:Cause of Death; D004646:Emphysema / Q000601:surgery / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011658:Pulmonary Fibrosis / Q000601:surgery / Q000628:therapy; D012131:Respiratory Insufficiency / Q000401:mortality / Q000628:therapy*; D014850:Waiting Lists
D002245:Carbon Dioxide