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The Homburg Lung: Efficacy and Safety of a Minimal-Invasive Pump-Driven Device for Veno-Venous Extracorporeal Carbon Dioxide Removal

Seiler, Frederik*; Trudzinski, Franziska C.*; Hennemann, Kai; Niermeyer, Tom; Schmoll, Christian; Kamp, Annegret*; Bals, Robert*; Muellenbach, Ralf M.§; Haake, Hendrik; Lepper, Philipp M.*

doi: 10.1097/MAT.0000000000000522
Pulmonary

Extracorporeal carbon dioxide removal (ECCO2R) is increasingly considered a viable therapeutic approach in the management of hypercapnic lung failure to avoid intubation or to allow lung-protective ventilator settings. This study aimed to analyze efficacy and safety of a minimal-invasive ECCO2R device, the Homburg lung. The Homburg lung is a pump-driven system for veno-venous ECCO2R with ¼″ tubing and a 0.8 m2 surface oxygenator. Vascular access is usually established via a 19F/21 cm bilumen cannula in the right internal jugular vein. For this work, we screened patient registries from two German centers for patients who underwent ECCO2R with the Homburg lung because of hypercapnic lung failure since 2013. Patients who underwent extracorporeal membrane oxygenation before ECCO2R were excluded. Patients who underwent ECCO2R more than one time were only included once. In total, 24 patients (aged 53.86 ± 12.49 years; 62.5% male) were included in the retrospective data analysis. Ventilatory failure occurred because of chronic obstructive pulmonary disease (50%), cystic fibrosis (16.7%), acute respiratory distress syndrome (12.5%), and other origins (20.8%). The system generated a blood flow of 1.18 ± 0.23 liters per minute (lpm). Sweep gas flow was 3.87 ± 2.97 lpm. Within 4 hours, paCO2 could be reduced significantly from 82.05 ± 15.57 mm Hg to 59.68 ± 12.27 mm Hg, thereby, increasing pH from 7.23 ± 0.10 to 7.36 ± 0.09. Cannulation-associated complications were transient arrhythmia (1/24 patients) and air embolism (1/24). Fatal complications did not occur. In conclusion, the Homburg lung provides effective carbon dioxide removal in hypercapnic lung failure. The cannulation is a safe procedure, with complication rates comparable to those in central venous catheter implantation.

From the *Department of Internal Medicine V–Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center, Homburg, Germany; Department of Thoracic and Cardiac Surgery, Division of Cardiovascular Perfusion, Saarland University Medical Center, Homburg, Germany; Maquet Clinical Concepts, MaquetGetinge Group, Rastatt, Germany; §Department of Anaesthesiology, University Hospital of Würzburg, Würzburg, Germany; and Kliniken Maria Hilf, Division of Cardiology, Electrophysiology and Critical Care Medicine, Mönchengladbach, Germany.

Submitted for consideration May 2016; accepted for publication in revised form December 2016.

Hendrik Haake and Philipp M. Lepper contributed equally to this work.

Disclosures: R. Muellenbach, H. Haake, and P.M. Lepper received travel reimbursement and speaker fees from Maquet Getinge Group. C. Schmoll is employee of Maquet Getinge Group. The other authors declare no conflict of interest.

Correspondence: Philipp M. Lepper, Division of Pneumology, Allergology, and Critical Care Medicine, Department of Internal Medicine, Saarland University Medical Center, D-66421 Homburg, Germany. Email: philipp.lepper@uks.eu.

Copyright © 2017 by the American Society for Artificial Internal Organs