Case Reports

Low-Flow Extracorporeal Carbon Dioxide Removal Using the Hemolung Respiratory Dialysis System^® to Facilitate Lung-Protective Mechanical Ventilation in Acute Respiratory Distress Syndrome

^* Divisions of Critical Care Medicine and Pulmonary and Sleep Medicine, Department of Internal Medicine, McGovern Medical School, Houston, Texas
^† Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital–Texas Medical Center, Houston, Texas
^‡ Department of Thoracic and Cardiovascular Surgery, McGovern Medical School, Houston, Texas
^§ Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

Address correspondence to: Kirti P. Patel, MPS, CCP, LP, CPBMT, Center for Advanced Heart Failure, McGovern Medical School and Memorial Hermann Hospital–Texas Medical Center, 6400 Fannin, Houston, TX 77030. E-mail: patelpump@sbcglobal.net

Received: 10 November 2016
Accepted: 27 February 2017

Abstract

Extracorporeal carbon dioxide removal (ECCO₂R) permits reductions in alveolar ventilation requirements that the lungs would otherwise have to provide. This concept was applied to a case of hypercapnia refractory to high-level invasive mechanical ventilator support. We present a case of an 18-year-old man who developed post-pneumonectomy acute respiratory distress syndrome (ARDS) after resection of a mediastinal germ cell tumor involving the left lung hilum. Hypercapnia and hypoxemia persisted despite ventilator support even at traumatic levels. ECCO₂R using a miniaturized system was instituted and provided effective carbon dioxide elimination. This facilitated establishment of lung-protective ventilator settings and lung function recovery. Extracorporeal lung support increasingly is being applied to treat ARDS. However, conventional extracorporeal membrane oxygenation (ECMO) generally involves using large cannulae capable of carrying high flow rates. A subset of patients with ARDS has mixed hypercapnia and hypoxemia despite high-level ventilator support. In the absence of profound hypoxemia, ECCO₂R may be used to reduce ventilator support requirements to lung-protective levels, while avoiding risks associated with conventional ECMO.