Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTSF12. Seventy-Two Hours Total Respiratory Support with aSingle Double-Lumen Cannula Placed in a VenousvenousPump-Driven Extracorporeal Lung MembraneDavid Sanchez-Lorente, Tetsuhiko Go, Philipp Jungebluth, Irene Rovira,Paolo Macchiarini *General Thoracic Surgical Experimental Laboratory, Universitat de Barcelona,Barcelona, SpainInvited Discussant: Jay ZwischenbergerOBJECTIVE: To investigate the safety and feasibility of obtaining total respiratorysupport during 72 hours using a pump-driven (Levitronix Centrimag ® centrifugalpump) venousvenous extracorporeal lung membrane (Novalung GmbH, Hechingen,Germany) attached via a single double-lumen cannula (Novalung GmbH)into the femoral or jugular vein in adult pigs.METHODS: Twelve pigs were initially ventilated for 2 hours (respiratory rate, 20–25breaths/min; tidal volume, 10–12 mL/Kg; fraction of inspired oxygen, 1.0; positiveend-expiratory pressure, 5 cm H 2 O). Thereafter, the extracorporeal lung membranewas attached to the right femoral (n = 6, 26 F cannula) or jugular vein (n = 6,22F cannula) using a single double-lumen cannula having one inflow venous andone outflow arterial channel. Ventilatory settings were then reduced to achievenear apneic ventilation (target settings: respiratory rate, 4 breath/min; tidal volume,1–2 mL/Kg; fraction of inspired oxygen, 1.0; positive end-expiratory pressure,10 cm H 2 O) and the pump flow increased hourly until maximal efficacy. Bloodgases and hemodynamics were measured every hour and bronchial lavages andplasmatic cytokines level performed 4 hourly.RESULTS: Mean blood flow through the device was 2.16 ± 0.43 L/min, and permittedan O2 transfer and CO2 removal 203.6 ± 54.6 and 590.3 ± 23.3 mL/min,respectively. Despite static ventilation, all pigs showed optimal respiratory supportduring the study period, being the mean PaO2, PaCO2 and SvO2 226.2 ± 56.4; 59.7± 8.8 and 85.6 ± 5.3 mmHg, respectively. There was no vasoactive drugs requirementto maintain hemodynamic stability (Table 1). Animals did not develop anysignificant changes regarding cytokine release or significant cellular trauma, andcoagulatory and inflammatory response over the 72 hours. The route of cannulation(femoral vs. jugular) and the size of the cannulae did not changed hemodynamicor respiratory parameters significantly.* AATS Member140