Carbon Dioxide Elimination During Veno-Venous Extracorporeal Membrane Oxygenation Weaning: A Pilot Study

Mirko Belliato, Luca Cremascoli*, Francesco Epis, Fiorenza Ferrari, Maria G. Quattrone, Maximilian Malfertheiner, Lars M. Broman, Anna Aliberti, Fabio S. Taccone, Giorgio A. Iotti, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V ' CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO. We enrolled patients with acute respiratory distress syndrome (ARDS). The V ' CO2NL ratio (V ' CO2NL/V ' CO2TOT) value was calculated based on the distribution of CO2 between the NL and the ML. Of 18 patients, 15 were successfully weaned off of V-V ECMO. In this subgroup, we observed a significant increase in the V ' CO2NL ratio comparing the median values of the first and last quartiles (0.32 vs. 0.53, p = 0.0045), without observing any modifications in the ventilation parameters. An increase in the V ' CO2NL ratio, independently from any change in ventilation could, despite the limitations of the study, indicate an improvement in pulmonary function and may be used as a weaning index for ECMO.

Original languageEnglish
Pages (from-to)700-708
Number of pages9
JournalAsaio Journal
Issue number6
Publication statusPublished - Jun 2021


  • acute respiratory distress syndrome
  • mechanical ventilation
  • veno-venous extracorporeal membrane oxygenation
  • extracorporeal carbon dioxide removal
  • extracorporeal membrane oxygenation weaning
  • ECMO


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