1. ABYLCAP CARBON DIOXIDE REMOVAL ECCO2R

2. TREATMENTS FOR CO2 REMOVAL
WHY ?

3. During the use of mechanical ventilation with low tidal volume, the exceeding CO2 arising from this “protective” technique is to be removed to avoid Acidosis .
Low tidal volume High tidal volume

4. ARF (Acute Respiratory Failure)
It’s an alteration in alveolar ventilation and / or a difficulty in pulmonary gas exchange, which can be determined by insufficient transport of oxygen to the tissues or by insufficient utilization of oxygen by peripheral tissues
ARDS (Acute Respiratory Distress Syndrome)
ARDS is a severe acute respiratory failure resulting from pulmonary edema caused by increased permeability of the alveolar capillary barrier.
ARDS is a specific lung disease, it is rather a severe pulmonary dysfunction due to underlying lung disease (sepsis, trauma, pneumonia).

5. Brain
How is CO2 distributed?
Heart
CO2 spreads from tissues and is moved to the alveolar capillaries in 3 different ways:
from about 3 to 5% in a physically diluted form (solubility 0,00069 mL/mL/mmHg)
from about 7 to 10% bound to the Hb through a carbaminic bind (carbo-hemoglobin)
More than 80% “interacts” in the red blood cell to turn into HCO3- in the plasmatic water
Kidney

6. } Tissues Plasma Red blood cell Capillary wall CO2 O2 Hb 3-5% 85-90%
HCO3-
Cl-
Na+
H2O
CO2 + H2O ca H2CO3
HCO3- H+ K+ } Hb
HHb
HbO2
Caboemoglobina
3-5%
85-90%
7-10%
Cl-

7. How does CO2 move “through”
the red blood cells?
Spreading from the tissues into the red blood cells, the CO2 catalyzes the hydration reaction through carbonic anhydrase: CO2 + H20 -> H2CO3
Then it dissociates: H2CO3 -> H+ + HCO3-
The hydrogen ion (H+) is buffered by the Hb, the bicarbonate ion (HCO3- ) moves from the red blood cell into plasma through a carrier protein of the erythrocyte membrane, simultaneously an exchange takes place with a chloride ion (Cl-)

8. } Capillary wall CO2 O2 Hb Lung Plasma Red Blood Cell
HCO3-
Cl-
Na+
H2O
CO2 + H2O ca H2CO3
HCO3- H+ K+ } Hb
HHb
HbO2
Caboemoglobina
Lung
Plasma
Red Blood Cell

9. How is CO2 expelled ?
The adverse reaction arises when the blood oxygenation causes an increase in the acidity of Hb and it involves the following:
A decrease in the buffer capacity with a release of ions H+
Hence: H+ + HCO3- -> H2CO3 -> H20 + CO2.
And the CO2 in excess is released

10. How is CO2 expelled ?
A decrease in the strength of the carbaminic binds between Hb and CO2 allows the release of CO2 by 7-10% transferred in the form of carbo-hemoglobin
Inside capillaries the effect leads to a higher intake of CO2 in blood because O2 is released from Hb
Inside pulmonary alveoli the effect leads to a higher output of CO2 from blood due to the fact that the Hb binds with O2

12. The inclination of the solubility curve between 40 and 45 mmHg is 0,0045 (mL/mL)/mmHg
Less than half of CO2 released in lungs is due to the 5 mmHg excursion down the venous dissociation curve.
The release of the remaining CO2 occurs due to the downwards shift of the dissociation curve, meaning the Haldane effect occurring when the pO2 changes from 40 mmHg (75% of O2 saturation) to 100 mmHg (100% O2 saturation)

13. The total quantity of CO2 in blood is proportional to its partial pressure

14. The factors that shift the dissociation curve of Hb
With the same value of pO2 we have greater or lesser percentage of saturation of Hb

15. The factors that shift the dissociation curve of Hb
With the same value of pO2 we have greater or lesser percentage of saturation of Hb

16. That’s why Abylcap was created for Lynda

17. Ossigenator O2
CO2

18. Characteristics The kit is made up of:
2 couples of Lines for extracorporeal circulation
2 heating Lines
1 Lilliput ECMO 2 Oxygenator
Connectors

19. Main characteristics Lilliput ECMO2 Oxygenator
Polymethylpentene membrane
Membrane surface 0,67 m2
Heater surface 0,02 m2
Filling volume 90 ml
Connections 1/4”- 5/16”
Maximum flow 2300 ml/min
5 days duration
ETO Sterilization

20. Non thrombogenic surfaces: PHISIO COATING

21. Characteristics of materials
ECMO Vs CPB
ECMO
CPB
Duration
Characteristics of materials
More than 21 days
Maximum 3,5 h

22. Plasma-tight membrane: POLYMETHYLPENTENE
Fibres in Polypropylene: gas comes into contact with blood through microporous fibres. The gas transfer is obtained through direct contact.
Polypropylene “standard“ membrane
Fibres in Polymethylpentene: the hollow fibres are protected by an external thin membrane. Gas transfer is obtained by diffusion.
Polymethylpentene “plasma-tight“ membrane

23. Plasma-tight membrane: POLYMETHYLPENTENE
OUTER SURFACE
Polymethylpentene “plasma-tight“ fibre
Main technical characteristics:
Gas transferred by diffusion (no direct contact blood  gas)
No plasma-breakthrough (>120h, according to Dideco test procedures)
Gas exchange capacity compared to other hollow fibers that work in direct contact (for the protection of the external surface 1 mm)
Suitable for long-lasting use
Polypropylene “standard“ fibre

25. Siggaard-Andersen

26. Siggaard-Andersen

27. 1) resorption of HCO3-
2) regeneration of HCO3-.

28. APPLICATION IN INTENSIVE CARE
Lynda is the first example of multidisciplinary approach
CPFA Treatment for patients with severe sepsis, septic shock or MOF
Intermittent Treatments for Renal Failure
Continuous Treatments for Renal Failure
Therapeutic Plasma Exchange Treatments
Treatments for CO2 Removal

29. Thanks to Lynda, Bellco can propose to the I.C. Units a
CONCLUSIONS
Thanks to Lynda, Bellco can propose to the I.C. Units a
“multi-organ support therapy” by integrating in one single device a support for:
ECCO2R Ventilation, TPE Plasma exchange , CVVH, CVVHD, CVVHDF Acute Renal Failure and CPFA Sepsis.