Dual Carbon Capture to Achieve Highly Efficient Extracorporeal Carbon Dioxide Removal in Hypercapnic Respiratory Failure
Abstract
Peer Reviewed Medical Research Program (PRMRP) Portfolio: Technology/Therapeutic Development Award Fiscal Year 2022 (FY22) PRMRP Topic Area: Respiratory Health FY22 PRMRP Strategic Goal: Prevent lung injury caused by mechanical ventilation Background: Chronic obstructive pulmonary disease (COPD) is a chronic lung condition with rising incidence that dramatically restricts an individual s quality of life. It impacts hundreds of millions worldwide and over 40% of all U.S. Veterans. Due primarily to the effects of either cigarette smoking or poor air quality, COPD results in the destruction of healthy lung tissue leading to impairment in the body s ability to ventilate and exhale adequate amounts of carbon dioxide (CO2). The effects of the COVID-19 pandemic are expected to further increase rates of COPD as millions of people infected by the SARS-CoV-2 virus experienced pulmonary complications resulting in persistent lung scarring. Patients with COPD are susceptible to acute exacerbations resulting in rapid increases in their CO2 levels resulting in hypercapnic respiratory failure (HRF) that can lead to systemic acidosis, somnolence, and death if untreated. Intubation and mechanical ventilation constitute the standard therapy for patients in HRF, but this is associated with prolonged duration of hospital stay, increased need for tracheostomy and chronic ventilatory support, and a mortality rate of 50% within 6 months of initial hospital admission. The complications of mechanical ventilation motivate the development of extracorporeal methods of directing removing CO2 from the blood to reduce or eliminate the need for invasive ventilatory support. Proposed Research: This project focuses on development of a novel extracorporeal device capable of removing physiologically significant amounts of CO2 at ultralow blood flow rates to create a readily accessible treatment for HRF. Using a dialysis-based approach, the proposed method is capable of removing more than 50% of the body s production of CO2 at a blood flow rate of only 250 ml per minute. This flow rate is comparable to those used in the low flow dialysis methods deployed to support critically ill patients in the intensive care unit and enables use of standard dialysis vascular cannula (13 Fr) easily placed by critical care and emergency medicine physicians. By relying on commonly used methods already widely present throughout the health care system, the proposed approach will facilitate rapid adoption and ready integration into existing clinical care. To achieve highly efficient capture of CO2 directly from the blood, X-COR Therapeutics has developed a method to target removal of CO2 present as both bicarbonate ion and dissolved gas. The proposed research consists of the development of a novel cartridge that integrates the ability to remove both bicarbonate ion via dialysis methods and dissolved gaseous CO2 via traditional oxygenator approaches. Device prototype development will proceed in parallel with benchtop studies to further refine the novel dialysate used to efficiently capture circulating bicarbonate ion. Device function and CO2 capture will be assessed in a large animal model of HRF to validate the overall approach. The final component of the proposed research will be to develop a computational model of the effects of extracorporeal CO2 removal to inform future clinical trial design required for regulatory approval and clinical use. Impact: The proposed research will lead to the development of a novel extracorporeal CO2 removal device capable of supporting patients with HRF. The realization of such an approach will transform the care of patients with COPD and chronic lung disease and will result in decreased hospital length of stay, improved patient vitality, and increased survival for COPD patients. This project will result in the manufacture of the X-COR hemofiltration system at Good Manufacturing Practices and evaluate the safety of t
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311047
Entities
People
- Steven Keller
Organizations
- Johns Hopkins University
- United States Army