Evaluation of the safety and efficacy of extracorporeal carbon dioxide removal in the critically ill using the PrismaLung+ device

Abstract

Background: Several extracorporeal carbon dioxide removal (ECCO₂R) devices are currently in use with variable efficacy and safety profiles. PrismaLung+ is an ECCO₂R device that was recently introduced into clinical practice. It is a minimally invasive, low flow device that provides partial respiratory support with or without renal replacement therapy. Our aim was to describe the clinical characteristics, efficacy, and safety of PrismaLung+ in patients with acute hypercapnic respiratory failure.

Methods: All adult patients who required ECCO₂R with PrismaLung+ for hypercapnic respiratory failure in our intensive care unit (ICU) during a 6-month period between March and September 2022 were included.

Results: Ten patients were included. The median age was 55.5 (IQR 41-68) years, with 8 (80%) male patients. Six patients had acute respiratory distress syndrome (ARDS), and two patients each had exacerbations of asthma and chronic obstructive pulmonary disease (COPD). All patients were receiving invasive mechanical ventilation at the time of initiation of ECCO₂R. The median duration of ECCO₂R was 71 h (IQR 57-219). A significant improvement in pH and PaCO₂ was noted within 30 min of initiation of ECCO₂R. Nine patients (90%) survived to weaning of ECCO₂R, eight (80%) survived to ICU discharge and seven (70%) survived to hospital discharge. The median duration of ICU and hospital stays were 14.5 (IQR 8-30) and 17 (IQR 11-38) days, respectively. There were no patient-related complications with the use of ECCO₂R. A total of 18 circuits were used in ten patients (median 2 per patient; IQR 1-2). Circuit thrombosis was noted in five circuits (28%) prior to reaching the expected circuit life with no adverse clinical consequences.

Conclusion(s): PrismaLung+ rapidly improved PaCO₂ and pH with a good clinical safety profile. Circuit thrombosis was the only complication. This data provides insight into the safety and efficacy of PrismaLung+ that could be useful for centres aspiring to introduce ECCO₂R into their clinical practice.

Keywords: Extracorporeal therapies; Hypercapnia; PrismaLung+; Respiratory acidosis; Respiratory failure.