title: The Homburg Lung: Efficacy and Safety of a Minimal-Invasive Pump-Driven Device for Veno-Venous Extracorporeal Carbon Dioxide Removal.
abstract: Extracorporeal carbon dioxide removal (ECCO2R) is increasingly considered a viable therapeutic approach in the management of hypercapnic lung failure to avoid intubation or to allow lung-protective ventilator settings. This study aimed to analyze efficacy and safety of a minimal-invasive ECCO2R device, the Homburg lung. The Homburg lung is a pump-driven system for veno-venous ECCO2R with ¼″ tubing and a 0.8 m surface oxygenator. Vascular access is usually established via a 19F/21 cm bilumen cannula in the right internal jugular vein. For this work, we screened patient registries from two German centers for patients who underwent ECCO2R with the Homburg lung because of hypercapnic lung failure since 2013. Patients who underwent extracorporeal membrane oxygenation before ECCO2R were excluded. Patients who underwent ECCO2R more than one time were only included once. In total, 24 patients (aged 53.86 ± 12.49 years; 62.5% male) were included in the retrospective data analysis. Ventilatory failure occurred because of chronic obstructive pulmonary disease (50%), cystic fibrosis (16.7%), acute respiratory distress syndrome (12.5%), and other origins (20.8%). The system generated a blood flow of 1.18 ± 0.23 liters per minute (lpm). Sweep gas flow was 3.87 ± 2.97 lpm. Within 4 hours, paCO2 could be reduced significantly from 82.05 ± 15.57 mm Hg to 59.68 ± 12.27 mm Hg, thereby, increasing pH from 7.23 ± 0.10 to 7.36 ± 0.09. Cannulation-associated complications were transient arrhythmia (1/24 patients) and air embolism (1/24). Fatal complications did not occur. In conclusion, the Homburg lung provides effective carbon dioxide removal in hypercapnic lung failure. The cannulation is a safe procedure, with complication rates comparable to those in central venous catheter implantation.
authors.affiliation: From the *Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany; †Department of Thoracic and Cardiac Surgery, Division of Cardiovascular Perfusion, Saarland University Medical Center, Homburg, Germany; ‡Maquet Clinical Concepts, MaquetGetinge Group, Rastatt, Germany; §Department of Anaesthesiology, University Hospital of Würzburg, Würzburg, Germany; and ¶Kliniken Maria Hilf, Division of Cardiology, Electrophysiology and Critical Care Medicine, Mönchengladbach, Germany.
authors.forename: Frederik
authors.initials: F
authors.lastname: Seiler
authors.forename: Franziska C
authors.initials: FC
authors.lastname: Trudzinski
authors.forename: Kai
authors.initials: K
authors.lastname: Hennemann
authors.forename: Tom
authors.initials: T
authors.lastname: Niermeyer
authors.forename: Christian
authors.initials: C
authors.lastname: Schmoll
authors.forename: Annegret
authors.initials: A
authors.lastname: Kamp
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.forename: Ralf M
authors.initials: RM
authors.lastname: Muellenbach
authors.forename: Hendrik
authors.initials: H
authors.lastname: Haake
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lepper
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood*; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D002245:Carbon Dioxide