Extracorporeal CO2 removal is a highly promising support therapy for patients with hypercapnic respiratory failure but whose clinical implementation and patient benefit is hampered by high cost and highly specialized expertise required for safe use. Current approaches target removal of the gaseous CO2 dissolved in blood which limits their ease of clinical use as high blood flow rates are required to achieve physiologically significant CO2 clearance. Here, a novel hybrid approach in which a zero-bicarbonate dialysis is used to target removal of bicarbonate ion coupled to a gas exchange device to clear dissolved CO2, achieves highly efficiently total CO2 capture while maintaining systemic acid-base balance. In a porcine model of acute hypercapnic respiratory failure, a CO2-reduction of 61.4 ± 14.4 mL/min was achieved at a blood flow rate of 248 mL/min using pediatric-scale priming volumes. The dialyzer accounted for 81% of total CO2 capture with an efficiency of 33% with a minimal pH change across the entire circuit. This study demonstrates the feasibility of a novel hybrid CO2 capture approach capable of achieving physiologically significant CO2 removal at ultralow blood flow rates with low priming volumes while leveraging widely available dialysis platforms to enable clinical adoption.

中文翻译：

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双重二氧化碳捕集可实现高效超低血流量体外二氧化碳清除。

对于高碳酸血症性呼吸衰竭的患者，体外去除二氧化碳是一种非常有前途的支持疗法，但是其安全性高昂的成本和高度专业化的技能阻碍了其临床实施和患者受益。当前的方法目标是去除溶解在血液中的气态二氧化碳，这限制了它们在临床上的易用性，因为需要高血流速度才能实现生理上显着的二氧化碳清除。在这里，一种新颖的混合方法（其中零碳酸氢盐渗析用于靶向去除与气体交换设备耦合的碳酸氢根离子以清除溶解的CO2）在保持系统酸碱平衡的同时，实现了高效的总CO2捕集。在急性高碳酸血症性呼吸衰竭的猪模型中，CO2减少量为61.4±14。使用儿科规模的灌注体积，血液流速为248 mL / min时达到4 mL / min。透析器占总二氧化碳捕集量的81％，效率为33％，整个回路的pH值变化最小。这项研究证明了一种新颖的混合CO2捕集方法的可行性，该方法能够以超低的血流量和低启动量实现生理上显着的CO2去除，同时利用广泛可用的透析平台来实现临床应用。