HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joseph B. Zwischenberger Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brunston, R. L. Articles by Zwischenberger, J. B. Search for Related Content PubMed PubMed Citation Articles by Brunston, R. L., Jr. Articles by Zwischenberger, J. B.

J Thorac Cardiovasc Surg 1997;114:1107-1114
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

PROLONGED HEMODYNAMIC STABILITY DURING ARTERIOVENOUS CARBON DIOXIDE REMOVAL FOR SEVERE RESPIRATORY FAILURE

Supported by Shriners Hospitals for Crippled Children (grant 8530).

Presented at the Twenty-ninth Annual Meeting of the American Burn Association, New York, N.Y., March 19–22, 1997.

Received for publication May 15, 1997 Revisions requested June 30, 1997 Revisions received July 31, 1997 Accepted for publication July 31, 1997 Address for reprints: Joseph B. Zwischenberger, MD, Division of Cardiothoracic Surgery, 301 University Blvd., University of Texas Medical Branch, Galveston, TX 77550-0528.

Abstract

Objective: The effects of prolonged arteriovenous carbon dioxide removal on hemodynamics during severe respiratory failure were evaluated in adult sheep with severe smoke inhalation injury. Methods: Adult female sheep ( n = 6, 33.8 ± 5.2 kg) were subjected to intratracheal cotton severe smoke insufflation to a mean carboxyhemoglobin level of 83% ± 3%. Twenty-four hours after injury, a low-resistance 2.5 m² membrane oxygenator was placed in a carotid-to-jugular pumpless arteriovenous shunt at unrestricted flow to allow complete carbon dioxide removal and reductions in ventilator support. Animals remained conscious, and heart rate, cardiac output, mean arterial pressure, and pulmonary arterial pressure were measured at baseline, after injury, and daily during support with the arteriovenous carbon dioxide removal circuit for 7 days. Results: All animals survived the study period. Carbon dioxide removal ranged from 99.7 ± 13.7 to 152.2 ± 16.2 ml/min, and five (83%) of the six animals were successfully weaned from the ventilator before day 7. During full support with the arteriovenous carbon dioxide removal circuit, shunt flow ranged from 1.24 ± 0.06 to 1.43 ± 0.08 L/min and accounted for 20.1% ± 1.4% to 25.9% ± 2.4% of cardiac output. No statistically significant changes in heart rate, cardiac output, mean arterial pressure, or pulmonary artery pressure were demonstrated over the study course despite the extracorporeal shunt flow. Conclusions: Arteriovenous carbon dioxide removal as a simplified means of extracorporeal gas exchange support is relatively safe without adverse hemodynamic effects or complications.

This article has been cited by other articles:

				J. Brederlau, R. Muellenbach, M. Kredel, U. Schwemmer, M. Anetseder, C. Greim, and N. Roewer The contribution of arterio-venous extracorporeal lung assist to gas exchange in a porcine model of lavage-induced acute lung injury Perfusion, September 1, 2006; 21(5): 277 - 284. [Abstract] [PDF]

				Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 719 - 723.

				X. Zhou, D. B Loran, D. Wang, B. R Hyde, S. D Lick, and J. B Zwischenberger Seventy-two hour gas exchange performance and hemodynamic properties of NOVALUNG(R)iLA as a gas exchanger for arteriovenous carbon dioxide removal Perfusion, December 1, 2005; 20(6): 303 - 308. [Abstract] [PDF]

				R. A. Vertrees, R. Nason, M. D. Hold, A. M. Leeth, F. C. Schmalstieg, P. J. Boor, and J. B. Zwischenberger Smoke/Burn Injury-Induced Respiratory Failure Elicits Apoptosis in Ovine Lungs and Cultured Lung Cells, Ameliorated With Arteriovenous CO2 Removal Chest, April 1, 2004; 125(4): 1472 - 1482. [Abstract] [Full Text] [PDF]

				J. B Zwischenberger and S. K Alpard Artificial lungs: a new inspiration Perfusion, July 1, 2002; 17(4): 253 - 268. [Abstract] [PDF]

				J A Murphy, C M Savage, S K Alpard, D J Deyo, J B Jayroe, and J B Zwischenberger Low-dose versus high-dose heparinization during arteriovenous carbon dioxide removal Perfusion, December 1, 2001; 16(6): 460 - 468. [Abstract] [PDF]

				J. B. Zwischenberger, S. K. Alpard, W. Tao, D. J. Deyo, and A. Bidani Percutaneous extracorporeal arteriovenous carbon dioxide removal improves survival in respiratory distress syndrome: A prospective randomized outcomes study in adult sheep J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 542 - 551. [Abstract] [Full Text] [PDF]

				J. B. Zwischenberger, S. A. Conrad, S. K. Alpard, L. R. Grier, and A. Bidani Percutaneous extracorporeal arteriovenous CO2 removal for severe respiratory failure Ann. Thorac. Surg., July 1, 1999; 68(1): 181 - 187. [Abstract] [Full Text] [PDF]

				J. B Zwischenberger, S. K Alpard, S. A Conrad, R. H Johnigan, and A. Bidani Arteriovenous carbon dioxide removal: development and impact on ventilator management and survival during severe respiratory failure Perfusion, July 1, 1999; 14(4): 299 - 310. [PDF]