title: Respiratory Electrodialysis. A Novel, Highly Efficient Extracorporeal CO2 Removal Technique.
abstract: BACKGROUND
  We developed an innovative, minimally invasive, highly efficient extracorporeal CO2 removal (ECCO2R) technique called respiratory electrodialysis (R-ED).
  
  
  OBJECTIVE
  To evaluate the efficacy of R-ED in controlling ventilation compared with conventional ECCO2R technology.
  
  
  METHODS
  Five mechanically ventilated swine were connected to a custom-made circuit optimized for R-ED, consisting of a hemofilter, a membrane lung, and an electrodialysis cell. Electrodialysis regionally modulates blood electrolyte concentration to convert bicarbonate to CO2 before entering the membrane lung, enhancing membrane lung CO2 extraction. All animals underwent three repeated experimental sequences, consisting of four steps: baseline (1 h), conventional ECCO2R (2 h), R-ED (2 h), and final NO-ECCO2R (1 h). Blood and gas flow were 250 ml/min and 10 L/min, respectively. Tidal volume was set at 8 ml/kg, and respiratory rate was adjusted to maintain arterial Pco2 at 50 mm Hg.
  
  
  RESULTS
  During R-ED, chloride and H(+) concentration increased in blood entering the membrane lung, almost doubling CO2 extraction compared with ECCO2R (112 ± 6 vs. 64 ± 5 ml/min, P < 0.001). Compared with baseline, R-ED and ECCO2R reduced minute ventilation by 50% and 27%, respectively. Systemic arterial gas analyses remained stable during the experimental phases. No major complication occurred, but there was an increase in creatinine level.
  
  
  CONCLUSIONS
  In this first in vivo application, we proved electrodialysis feasible and effective in increasing membrane lung CO2 extraction. R-ED was more effective than conventional ECCO2R technology in controlling ventilation. Further studies are warranted to assess the safety profile of R-ED, especially regarding kidney function.
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanella
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Castagna
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Salerno
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Scaravilli
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Salua
authors.initials: S
authors.lastname: Abd El Aziz El Sayed Deab
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Magni
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Giani
authors.affiliation: 2 Dipartimento di Scienze Veterinarie e Sanità Pubblica, Università degli Studi di Milano, Milano, Italy; and.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mazzola
authors.affiliation: 2 Dipartimento di Scienze Veterinarie e Sanità Pubblica, Università degli Studi di Milano, Milano, Italy; and.
authors.forename: Mariangela
authors.initials: M
authors.lastname: Albertini
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.|3 Dipartimento di Anestesia e Rianimazione, Ospedale San Gerardo, Monza, Italy.
authors.forename: Nicolò
authors.initials: N
authors.lastname: Patroniti
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mantegazza
authors.affiliation: 1 Dipartimento di Scienze della Salute, Università degli Studi di Milano Bicocca, Monza, Italy.|3 Dipartimento di Anestesia e Rianimazione, Ospedale San Gerardo, Monza, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood*; D003956:Dialysis; D005112:Extracorporeal Circulation / Q000379:methods*; D006935:Hypercapnia / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000097:blood / Q000150:complications* / Q000628:therapy; D013552:Swine; D013990:Tidal Volume
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide
keywords: carbon dioxide; extracorporeal circulation; hypercapnia; respiratory insufficiency