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J Thorac Cardiovasc Surg 2007;133:345
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Discussion

The first 20% of the full text of this article appears below.

Dr Michael S. Mulligan (Seattle, Wash). This work adds to the literature underscoring the point that pumpless atrioventricular support of gas exchange has a place in the care of the critically ill. CO2 removal and O2 transfer are physiologies that can be uncoupled and supported independently. I have several questions. The most consistent benefit demonstrated in the experience with the Affinity and NovaLung devices relates to improved outcomes with CO2 removal in patients with ARDS. Entirely adequate rates of CO2 removal are achievable with device flows as low as 800 to 1000 mL or 10% to 15% of CO. Therefore why is it necessary or desirable to divert 30% to the CO through the device?

The oxygen transfer rate across this device seems high. One would assume that to achieve that, the arterial blood inflow must be desaturated in the range of 65% or so. However, the low-frequency positive-pressure ventilation that you used and not apneic ventilation, in fact, is highly effective at maintaining oxygenation, as per the work of Kolobo. One would expect saturations in that paradigm in the range of 85% to 95%. . . . [Full Text of this Article]


Related Article

Experimental safety and efficacy evaluation of an extracorporeal pumpless artificial lung in providing respiratory support through the axillary vessels
Manuela Iglesias, Philipp Jungebluth, Oriol Sibila, Ivete Aldabo, María Purificación Matute, Carole Petit, Antoni Torres, and Paolo Macchiarini
J. Thorac. Cardiovasc. Surg. 2007 133: 339-345. [Abstract] [Full Text] [PDF]





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Copyright © 2007 by The American Association for Thoracic Surgery.