Evaluation of the safety and efficacy of extracorporeal carbon dioxide removal in the critically ill using the PrismaLung+ device

European Journal of Medical Research

Research

Eldho Paul¹  Jarryd Ludski²  Sachin Gupta³  Ravindranath Tiruvoipati⁴  Ashwin Subramaniam⁵  Mallikarjuna Ponnapa Reddy⁶  Kavi Haji⁷ 

[1] ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, 3004, Melbourne, VIC, Australia;Alfred Hospital, Melbourne, VIC, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia;ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, 3004, Melbourne, VIC, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia;ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, 3004, Melbourne, VIC, Australia;Department of Intensive Care Medicine, Dandenong Hospital, Dandenong, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia;Department of Intensive Care, Calvary Hospital, Canberra, ACT, Australia;Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, 3199, Frankston, VIC, Australia;Division of Medicine, Peninsula Clinical School, Monash University, Frankston, VIC, Australia;Department of Surgery, University of Melbourne, Melbourne, VIC, Australia;

关键词: Hypercapnia;    Respiratory failure;    Respiratory acidosis;    Extracorporeal therapies;    PrismaLung+;   

DOI  :  10.1186/s40001-023-01269-2

 received in 2023-06-02, accepted in 2023-08-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSeveral extracorporeal carbon dioxide removal (ECCO2R) devices are currently in use with variable efficacy and safety profiles. PrismaLung+ is an ECCO2R device that was recently introduced into clinical practice. It is a minimally invasive, low flow device that provides partial respiratory support with or without renal replacement therapy. Our aim was to describe the clinical characteristics, efficacy, and safety of PrismaLung+ in patients with acute hypercapnic respiratory failure.MethodsAll adult patients who required ECCO2R with PrismaLung+ for hypercapnic respiratory failure in our intensive care unit (ICU) during a 6-month period between March and September 2022 were included.ResultsTen patients were included. The median age was 55.5 (IQR 41–68) years, with 8 (80%) male patients. Six patients had acute respiratory distress syndrome (ARDS), and two patients each had exacerbations of asthma and chronic obstructive pulmonary disease (COPD). All patients were receiving invasive mechanical ventilation at the time of initiation of ECCO2R. The median duration of ECCO2R was 71 h (IQR 57–219). A significant improvement in pH and PaCO2 was noted within 30 min of initiation of ECCO2R. Nine patients (90%) survived to weaning of ECCO2R, eight (80%) survived to ICU discharge and seven (70%) survived to hospital discharge. The median duration of ICU and hospital stays were 14.5 (IQR 8–30) and 17 (IQR 11–38) days, respectively. There were no patient-related complications with the use of ECCO2R. A total of 18 circuits were used in ten patients (median 2 per patient; IQR 1–2). Circuit thrombosis was noted in five circuits (28%) prior to reaching the expected circuit life with no adverse clinical consequences.Conclusion(s)PrismaLung+ rapidly improved PaCO2 and pH with a good clinical safety profile. Circuit thrombosis was the only complication. This data provides insight into the safety and efficacy of PrismaLung+ that could be useful for centres aspiring to introduce ECCO2R into their clinical practice.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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