A CO₂ removal system using extracorporeal lung and renal assist device with an acid and alkaline infusion

The patients with respiratory failure need high tidal volume by mechanical ventilation, which lead to the ventilator-induced lung injury. We developed an extracorporeal lung and renal assist device (ELRAD), comprising acid infusion, membrane lung, continuous hemodiafiltration and alkaline infusion. To evaluate this system, we conducted in vivo studies using experimental swine which were connected to the new system. In vivo experiments consist of four protocols; baseline = hemodiafiltration only (no O₂ gas flow to membrane lung); membrane lung = “Baseline” plus O₂ gas flow to membrane lung; “Acid infusion” = “Membrane lung” plus continuous acid infusion; ELRAD = “Acid infusion” plus continuous alkaline infusion. We changed the ventilatory rate of the mechanical ventilation to maintain PCO₂ at 50–55 mmHg during the four protocols. The results showed that there was statistically no significant difference in the levels of pH, HCO₃ ⁻, and base excess when each study protocol was initiated. The amount of CO₂ eliminated by the membrane lung significantly increased by 1.6 times in the acid infusion protocol and the ELRAD protocol compared to the conventional membrane lung protocol. Minute ventilation in the ELRAD protocol significantly decreased by 0.5 times compared with the hemodiafiltration only protocol (P < 0.0001), the membrane lung (P = 0.0006) and acid infusion protocol (P = 0.0017), respectively. In conclusion, a developed CO₂ removal system efficiently removed CO₂ at low blood flow and reduced minute ventilation, while maintaining acid–base balance within the normal range.