Low-flow veno-venous extracorporeal CO2 removal: first clinical experience in lung transplant recipients.

Patients undergoing lung transplantation (LT) often show a progressive derangement of PaCO2 and pH during and immediately after the procedure. Although aggressive mechanical ventilation is required to maintain adequate gas exchange, it may increase the risk of ventilator-induced lung injury (VILI). During lung transplantation, partial extracorporeal CO2 removal (ECCO2-R) might play an effective role in supporting respiratory function and may represent a valuable option for reducing hypercapnia and respiratory acidosis (1). In spite of its invasiveness and the high incidence of complications restricting its use, this may be a promising technique help to avoid VILI (2). ECCO2-R devices were initially proposed by Kolobow (3), leading to a number of systems currently available in the clinical arsenal. One of the first revised ECCO2-R systems was the Interventional Lung Assist (ILA; NovaLung, Hecnigen, Germany), which consists of a low-resistance arterovenous pumpless device. It requires hemodynamic stability, since its efficacy is influenced by the artero-venous pressure difference (mean arterial pressure >70 mmHg and a cardiac index >3 l/min per m2). More recently, low-flow veno-venous ECCO2-R systems (LFVV-ECCO2-R) have progressively gained acceptance. Our experience with LFVV-ECCO2-R devices started with the Decap system (Hemodec, Salerno, Italy), which consists in a small oxygenator combined with a dialysis filter. These kind of devices are minimally invasive and require only one small, double-lumen, central venous access `