Introducing the Homburg lung: Efficacy and safety of a minimal-invasive system for extracorporeal CO₂ removal

Abstract

Introduction: Extracorporeal CO₂ removal (ECCO₂R) is increasingly used as a therapeutic strategy in hypercapnic lung failure in order to avoid intubation, to allow lung protective ventilator settings, or to facilitate weaning from invasive ventilation. Here, we report on the Homburg Lung, a novel minimal-invasive mid-flow ECCO₂R system which was established and successfully used at our ICU. The Homburg Lung is a pump-driven (Maquet Rotaflow) system for veno-venous ECCO₂R with ¼” tubing and a 0.8 m² surface oxygenator (Maquet Quadrox-I pediatric). Vascular access is usually established via a 19F/21cm bilumen cannula in the right internal jugular vein.

Methods: To analyse efficacy and safety of the Homburg Lung, we screened our patient registry for ECCO₂R procedures since 2013. Patients who underwent ECMO prior to ECCO₂R were excluded. Patients who underwent ECCO₂R more than one time since 2013 were only included once.

Results: A total of 19 patients (age 52.3 ± 12.86 years, 42.1% female) was analysed. Ventilatory failure occurred due to COPD (47.4%), cystic fibrosis (21 %), and other origins (31.6%). The system generated a blood flow of 1.23 ± 0.29 lpm. Gas flow was 5.37 ± 2.98 lpm. Within 4 h, pCO₂ could be reduced from 74.03 ± 17.51 mmHg to 55.53 ± 10.85 mmHg. Cannulation-associated complications were transient arrhythmia (1/19 patients), pneumothorax (1/19), and air embolism (1/19). Fatal complications were not registered.

Conclusion: The Homburg Lung provides effective CO₂ removal in hypercapnic lung failure. The cannulation is a safe procedure with complication rates comparable to those in central venous catheter implantation.