Arterio-Venous CO 2 Removal (AVCO 2 R) Perioperative Management: Rapid Recovery and Enhanced Survival

Abstract

Percutaneous arteriovenous CO 2 removal (AVCO 2 R) uses a simple arteriovenous (A-V) shunt for near-total CO 2 removal that allows significant reductions in minute ventilation. We critically reviewed our algorithm-directed perioperative anesthesia management in our LD 40 ovine smoke-burn injury model of acute respiratory distress syndrome (ARDS) treated with AVCO 2 R. 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% O 2 ; (2) When PaO 2 /FiO 2 < 200(48-52 h), sheep randomized to the AVCO 2 R ( n = 8) or SHAM ( n = 8) procedure. Induction: 66% N 2 O and 5% isoflurane in balance O 2 . Maintenance: 1.5-2.5% isoflurane in 100% O 2 for AVCO 2 R, 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 AVCO 2 R specifically.

• Ards
• Avco2r
• Co2 Removal
• Ecmo
• Mechanical Ventilation
• Membrane Oxygenator
• Permissive Hypercapnia
• Sheep
• Respiratory Failure