Résumé
Background: extracorporeal CO2 removal (ECCO2R) struggles to demonstrate an added value in care of acute respiratory failure because of a lack of efficacy. The main goal of present study was to determine the influence of ECCO2R configuration and recirculation on extracorporeal decarboxylation. Methods: this single center retrospective study was conducted between January 2018 and May 2024. All patients who needed high-flow ECCO2R (>2L/min) were included in present study. Four configurations were performed using ECMO device and ipsilateral cannulation site: central jugulojugular and femoro-femoral configurations, distal jugulo-jugular and femoro-femoral configurations. The influence of configuration and recirculation coefficient on the association decarboxylation index CO2 elimination was studied by mixed linear regression. Results: eighteen patients were treated with high-flow ECCO2R. Extracorporeal blood flows (median of 2.6L/min [IQR, 2.0-2.6L/min]) were comparable between the configurations (P=0.33), even if values higher than 2.5L/min were observed in central configuration. Median CO2 elimination was 110mL STPD*min-1 (IQR, 83-149mL STPD*min-1). Recirculation coefficient was significantly higher with the distal drainage configurations (13% [IQR, 7-18%], 30% [IQR, 24-33], 55% [IQR, 45-56] and 82% [IQR, 67-82%], respectively; p<0.001). Distal drainage configurations and high recirculation coefficient were significantly associated in multivariable analysis with a reduced CO2 elimination (P<0.001). Conclusion: we reported four different configurations of high-flow ECCO2R with either central or distal drainage. Better rheological conditions and lower recirculation were observed using a central drainage configuration, which lead to a better decarboxylation dose.