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Chest. 2013 Mar;143(3):678-686. doi: 10.1378/chest.12-0228.

A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.

Author information

1
University of Connecticut Health Center, Farmington, CT. Electronic address: nburki@uchc.edu.
2
Artemis Health Sciences, Gurgaon, India.
3
Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.
4
Ruhrlandklinik, Essen, Germany.
5
Asklepios Klinik Barmbek, Hamburg, Germany.
6
Institute of Pneumology, Universität Witten/Herdecke, Krankenhaus Bethanien, Solingen, Germany.
7
Klinik Donaustauf, Donaustauf, Germany.
8
University of Bonn, Bonn, Germany.
9
Georg-August-Universität Göttingen, Göttingen, Germany.

Abstract

BACKGROUND:

Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients.

METHODS:

This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean.

RESULTS:

The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization.

CONCLUSIONS:

This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00987740 NCT01021605.

PMID:
23460154
PMCID:
PMC3590884
DOI:
10.1378/chest.12-0228
[Indexed for MEDLINE]
Free PMC Article

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