Extracorporeal CO2removal for refractory hypercapnia in acute respiratory failure: A case series

Introduction: Although Non-Invasive Ventilation (NIV) can be effective to support the failing ventilatory pump, its failure rate remains high. Extracorporeal CO 2 removal (ECCO 2 R) is now being increasingly suggested for the management of patients with ARF refractory to NIV to avoid utilization of Invasive Mechanical Ventilation (IMV). Aims: To describe the use of a pump-assisted venovenous system for ECCO 2 R as a measure to avoid IMV in the event of NIV failure. Methods: 7 patients (4M/3F; age: 62.7±19.3 yrs) at high risk for NIV failure underwent ECCO 2 R with the [ProLUNG, Estor] system between Jan 2015 and Jan 2016. Causes of ARF that led to utilization of such device were COPD exacerbation ( n= 3), exacerbation of IPF ( n= 2), Non-Cystic Fibrosis Bronchiectasis ( n= 1), and a pneumothorax complicating Lymphangioleiomyomatosis ( n= 1) . Results: Mean time on ECCO 2 R system was 83.3±30.7 hrs. One patient died on the device; 5 recovered and were weaned from the device after 3 to 5 days; one patients was bridged to lung transplant. Mean PaCO 2 on the extracorporeal gas exchanger was significantly lower at 48 hours after implantation compared to baseline (53.1±6.7 vs 70.4±13.4 mmHg; P≤ .02). Conclusions: Preliminary data from our experience support the view that utilization of ECCO 2 R is feasible and effective in some severe forms of ARF refractory to NIV in which the primary problem is CO 2 retention.