218: Awake, Ambulatory Bridge to Lung Transplant Utilizing Extracorporeal Carbon Dioxide Removal (ECCO2R)

Introduction: Bridge to lung transplantation using extracorporeal support is well accepted, ideally in an awake and ambulatory configuration. Few reports exist on the utilization of ECCO2R as a bridge to lung transplantation. Clinical Summary: A 61-year-old male with interstitial lung disease was evaluated and approved for lung transplantation. He was admitted urgently to the ICU with hypercapnic respiratory failure and a PaCO2 of 110mmHg. Oxygenation was sufficiently supplemented with nasal cannula, but titration to continuous non-invasive-ventilation (NIV) occurred which was prohibitive to nutrition and conditioning. A multidisciplinary decision was made to proceed with ECCO2R bridge. Utilizing local anesthetic and ultrasound-guidance, the right common femoral vein was percutaneously cannulated with a Hemolung® 15.5-French catheter after administration of 2500units of intravenous heparin. Initial settings of 450mL/min flow, 1300rpm, and sweep of 8L/min (CO2 removal of 108ml/min), corrected the PCO2 from 107mmHg to 77.7mmHg. Over the next ten days, average parameters included: 520ml/min flow, 1350rpm, sweep 10L/min, approximate CO2 removal 88ml/min, and serum CO2 level ~63mmHg (Table 1). Nocturnal NIV and 2-4L oxygen supplementation enabled ambulation >900ft. Subcutaneous heparin (5000units q8hours) was utilized without hemorrhagic or thrombotic complication. On day 11 of extracorporeal support, bilateral lung transplantation was performed with catheter decannulation and discharge occurred 22 days post-operatively. Discussion: Awake, ambulatory ECCO2R can be safely and effectively utilized as a bridge to lung transplantation in predominantly hypercapnic respiratory failure. Exercise tolerance can be achieved with low flow and via femoral cannulation. Therapeutic anticoagulation was avoided which possibly mitigated bleeding risk without circuit thrombosis.