Arterio-venous CO2 removal (AVCO2R) perioperative management

Rapid recovery and enhanced survival

Joseph B. Zwischenberger, Clare Savage, Sarah A. Witt, Scott K. Alpard, Donald D. Harper, Donald J. Deyo

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Percutaneous arteriovenous CO2 removal (AVCO2R) uses a simple arteriovenous (A-V) shunt for near-total CO2 removal that allows significant reductions in minute ventilation. We critically reviewed our algorithm-directed perioperative anesthesia management in our LD40 ovine smoke-burn injury model of acute respiratory distress syndrome (ARDS) treated with AVCO2R. General anesthesia is required for: (1) Vascular access followed by ARDS model development by smoke insufflation (36 breaths) plus 40% TBSA III° burn with mechanical ventilation. Induction: 12.5 mg/kg im ketamine and 4% halothane by mask, then intubation. Maintenance: 1.0-2.5% halothane in 100% O2; (2) When PaO2/FiO2 < 200 (48-52 h), sheep randomized to the AVCO2R (n = 8) or SHAM (n = 8) procedure. Induction: 66% N2O and 5% isoflurane in balance O2. Maintenance: 1.5-2.5% isoflurane in 100% O2 for AVCO2R, cannulation (10F carotid artery, 14F jugular vein); (3) Postop, both groups had algorithm-directed ventilator management, identical heparin (ACT > 300 s), fluid, and analgesia management. All sheep met criteria for ARDS, survived anesthesia, and were standing by 0.5-5 h. There were no complications attributable to anesthesia. The absence of anesthesia-related complications allows model development for outcomes studies for ARDS in general and AVCO2R specifically.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
JournalJournal of Investigative Surgery
Volume15
Issue number1
DOIs
StatePublished - 2002
Externally publishedYes

Fingerprint

Adult Respiratory Distress Syndrome
Anesthesia
Halothane
Smoke
Sheep
Insufflation
Ketamine
Masks
Burns
Artificial Respiration
Intubation
Analgesia
General Anesthesia
Blood Vessels
Ventilation
Maintenance
Outcome Assessment (Health Care)
Wounds and Injuries

Keywords

  • ARDS
  • AVCOR
  • CO removal
  • ECMO
  • Mechanical ventilation
  • Membrane oxygenator
  • Permissive hypercapnia
  • Respiratory failure
  • Sheep

ASJC Scopus subject areas

  • Surgery

Cite this

Zwischenberger, J. B., Savage, C., Witt, S. A., Alpard, S. K., Harper, D. D., & Deyo, D. J. (2002). Arterio-venous CO2 removal (AVCO2R) perioperative management: Rapid recovery and enhanced survival. Journal of Investigative Surgery, 15(1), 15-21. https://doi.org/10.1080/08941930252807741

Arterio-venous CO2 removal (AVCO2R) perioperative management : Rapid recovery and enhanced survival. / Zwischenberger, Joseph B.; Savage, Clare; Witt, Sarah A.; Alpard, Scott K.; Harper, Donald D.; Deyo, Donald J.

In: Journal of Investigative Surgery, Vol. 15, No. 1, 2002, p. 15-21.

Research output: Contribution to journalArticle

Zwischenberger, JB, Savage, C, Witt, SA, Alpard, SK, Harper, DD & Deyo, DJ 2002, 'Arterio-venous CO2 removal (AVCO2R) perioperative management: Rapid recovery and enhanced survival', Journal of Investigative Surgery, vol. 15, no. 1, pp. 15-21. https://doi.org/10.1080/08941930252807741
Zwischenberger, Joseph B. ; Savage, Clare ; Witt, Sarah A. ; Alpard, Scott K. ; Harper, Donald D. ; Deyo, Donald J. / Arterio-venous CO2 removal (AVCO2R) perioperative management : Rapid recovery and enhanced survival. In: Journal of Investigative Surgery. 2002 ; Vol. 15, No. 1. pp. 15-21.
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