title: Single-Site Cannulation Venovenous Extracorporeal CO2 Removal as Bridge to Lung Volume Reduction Surgery in End-Stage Lung Emphysema.
abstract: Lung volume reduction surgery (LVRS) is an important treatment option for end-stage lung emphysema in carefully selected patients. Here, we first describe the application of low-flow venovenous extracorporeal CO2 removal (LFVV-ECCO2R) as bridge to LVRS in patients with end-stage lung emphysema experiencing severe hypercapnia caused by acute failure of the breathing pump. Between March and October 2015, n = 4 patients received single-site LFVV-ECCO2R as bridge to LVRS. Indication for extracorporeal lung support was severe hypercapnia with respiratory acidosis and acute breathing pump failure. Two patients required continuous mechanical ventilation over a temporary tracheostomy and were bed ridden. The other two patients were nearly immobile because of severe dyspnea at rest. Length of preoperative ECCO2R was 14 (1-42) days. All patients underwent unilateral LVRS. Anatomical resection of the right (n = 3) or left (n = 1) upper lobe was performed. Postoperatively, both patients with previous mechanical ventilatory support were successfully weaned. ECCO2R in patients with end-stage lung emphysema experiencing severe hypercapnia caused by acute breathing pump failure is a safe and effective bridging tool to LVRS. In such patients, radical surgery leads to a significant improvement of the performance status and furthermore facilitates respiratory weaning from mechanical ventilation.
authors.affiliation: From the *Department of Thoracic Surgery and Lung Support, †Department of Anesthesiology and Intensive Care Medicine, ‡Department of Respiratory Medicine and Thoracic Oncology, §Department of Radiology, Ibbenbueren General Hospital, Ibbenbueren, Germany; and ¶Department of Respiratory Medicine and Pulmonary Rehabilitation, Karl-Hansen-Hospital, Bad Lippspringe, Germany.
authors.forename: Bassam
authors.initials: B
authors.lastname: Redwan
authors.forename: Stephan
authors.initials: S
authors.lastname: Ziegeler
authors.forename: Michael
authors.initials: M
authors.lastname: Semik
authors.forename: Joachim
authors.initials: J
authors.lastname: Fichter
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dickgreber
authors.forename: Volker
authors.initials: V
authors.lastname: Vieth
authors.forename: Erik Christian
authors.initials: EC
authors.lastname: Ernst
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischer
mesh_terms: D002245:Carbon Dioxide / Q000097:blood / Q000302:isolation & purification*; D002404:Catheterization; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000601:surgery*; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide