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 Scopus citations

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 - Apr 15 2002

Keywords

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

ASJC Scopus subject areas

  • Surgery

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    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