ABYLCAP CARBON DIOXIDE REMOVALECCO2R

TREATMENTS FOR CO2 REMOVAL

WHY ?

During the use of mechanical ventilation with low tidal volume, the exceeding CO2 arising from this “protective” technique is to

be removed to avoid Acidosis .

Low tidal volume High tidal volume

ARF (Acute Respiratory Failure)

It’s an alteration in alveolar ventilation and / or a difficulty in pulmonary gas exchange, which can be determined by insufficient transport of oxygen to the tissues or by insufficient utilization of oxygen by peripheral tissues

ARDS (Acute Respiratory Distress Syndrome)ARDS is a severe acute respiratory failure resulting from pulmonary edema caused by increased permeability of the alveolar capillary barrier.

ARDS is a specific lung disease, it is rather a severe pulmonary dysfunction due to underlying lung disease (sepsis, trauma, pneumonia).

Heart

Kidney

Brain

CO2 spreads from tissues and is moved to the alveolar capillaries in 3 different ways:

• from about 3 to 5% in a physically diluted form (solubility 0,00069 mL/mL/mmHg)

• from about 7 to 10% bound to the Hb through a carbaminic bind (carbo-hemoglobin)

• More than 80% “interacts” in the red blood cell to turn into HCO3

- in the plasmatic water

How is CO2 distributed?

Cl-

Tissues Plasma Red blood cell

Capillary w

all

CO2

O2 O2

HCO3-

Cl-

Na+

H2O

CO2 + H2O ca H2CO3

HCO3- H+

K+

H2O

O2

}Hb

}HHb

HbO2

CO2

O2

CO2

3-5%

85-90%

7-10%

CO2

Cl-

Spreading from the tissues into the red blood cells, the CO2 catalyzes the hydration reaction through carbonic anhydrase: CO2 + H20 -> H2CO3

• Then it dissociates: H2CO3 -> H+ + HCO3-

• The hydrogen ion (H+) is buffered by the Hb, the bicarbonate ion (HCO3

- ) moves from the red blood cell into plasma through a carrier protein of the erythrocyte membrane, simultaneously an exchange takes place with a chloride ion (Cl-)

How does CO2 move “through” the red blood cells?

Lung Plasma Red Blood Cell

Capillary w

all

CO2

O2 O2

HCO3-

Cl-

Na+

H2O

CO2

CO2 + H2O ca H2CO3

HCO3- H+

K+

H2O

O2

}Hb

}HHb

HbO2

CO2

O2

Cl-

CO2

The adverse reaction arises when the blood oxygenation causes an increase in the acidity of Hb and it involves the following: • A decrease in the buffer capacity with a release of

ions H+ • Hence: H+ + HCO3

- -> H2CO3 -> H20 + CO2. • And the CO2 in excess is released

How is CO2 expelled ?

A decrease in the strength of the carbaminic binds between Hb and CO2 allows the release of CO2 by 7-10% transferred in the form of carbo-hemoglobin

• Inside capillaries the effect leads to a higher intake of CO2 in blood because O2 is released from Hb

• Inside pulmonary alveoli the effect leads to a higher output of CO2 from blood due to the fact that the Hb binds with O2

How is CO2 expelled ?

The inclination of the solubility curve between 40 and 45 mmHg is 0,0045 (mL/mL)/mmHg

Less than half of CO2 released in lungs is due to the 5 mmHg excursion down the venous dissociation curve.

The release of the remaining CO2 occurs due to the downwards shift of the dissociation curve, meaning the Haldane effect occurring when the pO2 changes from 40 mmHg (75% of O2 saturation) to 100 mmHg (100% O2 saturation)

The total quantity of CO2 in blood is proportional to its partial pressure

The factors that shift the dissociation curve of Hb

With the same value of pO2 we have greater or lesser percentage of saturation of Hb

The factors that shift the dissociation curve of Hb

With the same value of pO2 we have greater or lesser percentage of saturation of Hb

That’s why Abylcap was created for Lynda

Ossigenator

CO2

O2

Characteristics

The kit is made up of:• 2 couples of Lines for extracorporeal circulation• 2 heating Lines• 1 Lilliput ECMO 2 Oxygenator• Connectors

Main characteristics

• Lilliput ECMO2 Oxygenator• Polymethylpentene membrane• Membrane surface 0,67 m2

• Heater surface 0,02 m2

• Filling volume 90 ml• Connections 1/4”- 5/16”• Maximum flow 2300 ml/min• 5 days duration• ETO Sterilization

Non thrombogenic surfaces: PHISIO COATING

COATINGCOATING

ECMO CPBDuration

Characteristics of materials

ECMO Vs CPB

More than 21 days Maximum 3,5 h

Polypropylene “standard“ membrane

Polymethylpentene “plasma-tight“ membrane

Fibres in Polypropylene: gas comes into contact with blood through microporous

fibres. The gas transfer is obtained

through direct contact.

Fibres in Polypropylene: gas comes into contact with blood through microporous

fibres. The gas transfer is obtained

through direct contact.

Fibres in Polymethylpentene: the hollow fibres are protected

by an external thin membrane. Gas transfer is

obtained by diffusion.

Fibres in Polymethylpentene: the hollow fibres are protected

by an external thin membrane. Gas transfer is

obtained by diffusion.

Plasma-tight membrane: POLYMETHYLPENTENE

Polymethylpentene “plasma-tight“ fibre

Polypropylene “standard“ fibre

OUTER SURFACE

Plasma-tight membrane: POLYMETHYLPENTENE

Main technical characteristics:

Gas transferred by diffusion (no direct contact blood gas)

No plasma-breakthrough (>120h, according to Dideco test

procedures)

Gas exchange capacity compared to other hollow fibers that

work in direct contact (for the protection of the external

surface 1 mm)

Suitable for long-lasting use

Siggaard-Andersen

Siggaard-Andersen

1) resorption of HCO3-

2) regeneration of HCO3-.

Lynda is the first example of multidisciplinary approach

Continuous Treatments for Renal Failure

Intermittent Treatments for Renal Failure

CPFA Treatment for patients with severe sepsis, septic shock or MOF

Therapeutic Plasma Exchange Treatments

APPLICATION IN INTENSIVE CARE

Treatments for CO2 Removal

CONCLUSIONS

Thanks to Lynda, Bellco can propose to the I.C. Units a “multi-organ support therapy” by integrating in one single

device a support for:ECCO2R Ventilation, TPE Plasma exchange , CVVH, CVVHD,

CVVHDF Acute Renal Failure and CPFA Sepsis.