Enhanced Extracorporeal CO2 Removal by Regional Blood Acidification: Effect of Infusion of Three Metabolizable Acids. Issue 5 (September 2015)

• Record Type: Journal Article
• Authors: Scaravilli, Vittorio; Kreyer, Stefan; Linden, Katharina; Belenkiy, Slava; Pesenti, Antonio; Zanella, Alberto; Cancio, Leopoldo C.; Batchinsky, Andriy I.
• Is Part Of: ASAIO journal. Volume 61:Issue 5(2015)
• Publication Date: 2015-09
• Subjects: extracorporeal circulation -- carbon dioxide -- lactic acid -- citric acid -- acetic acid; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000000238
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Acidification of blood entering a membrane lung (ML) with lactic acid enhances CO2 removal (VCO2 ML). We compared the effects of infusion of acetic, citric, and lactic acids on VCO2 ML. Three sheep were connected to a custom-made circuit, consisting of a Hemolung device (Alung Technologies, Pittsburgh, PA), a hemofilter (NxStage, NxStage Medical, Lawrence, MA), and a peristaltic pump recirculating ultrafiltrate before the ML. Blood flow was set at 250 ml/min, gas flow (GF) at 10 L/min, and recirculating ultrafiltrate flow at 100 ml/min. Acetic (4.4 M), citric (0.4 M), or lactic (4.4 M) acids were infused in the ultrafiltrate at 1.5 mEq/min, for 2 hours each, in randomized fashion. VCO2 ML was measured by the Hemolung built-in capnometer. Circuit and arterial blood gas samples were collected at baseline and during acid infusion. Hemodynamics and ventilation were monitored. Acetic, citric, or lactic acids similarly enhanced VCO2 ML (+35%), from 37.4 ± 3.6 to 50.6 ± 7.4, 49.8 ± 5.6, and 52.0 ± 8.2 ml/min, respectively. Acids similarly decreased pH, increased p CO2, and reduced HCO3 − of the post-acid extracorporeal blood sample. No significant effects on arterial gas values, ventilation, or hemodynamics were observed. In conclusion, it is possible to increase VCO2 ML by more than one-third using any one of the three metabolizable acids. Abstract : Supplemental Digital Content is available in the text.