Daily use of extracorporeal CO2 removal in a critical care unit: indications and results

Hadrien Winiszewski; François Aptel; François Belon; Nicolas Belin; Claire Chaignat; Cyrille Patry; Cecilia Clermont; Elise David; Jean-Christophe Navellou; Guylaine Labro; Gaël Piton; Gilles Capellier

doi:10.1186/s40560-018-0304-x

Daily use of extracorporeal CO₂ removal in a critical care unit: indications and results

J Intensive Care. 2018 Jun 28:6:36. doi: 10.1186/s40560-018-0304-x. eCollection 2018.

Authors

Affiliations

¹ Medical Intensive Care Unit, Besançon, France.
² 2Service de Réanimation Médicale, CHU de Besançon, 25030 Besançon, France.
³ 4Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besançon, France.
⁴ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia.

Abstract

Background: While outcome improvement with extracorporeal CO₂ removal (ECCO₂R) is not demonstrated, a strong pathophysiological rational supports its use in the setting of acute respiratory distress syndrome (ARDS) and COPD exacerbation. We aimed to describe our single-center experience of ECCO₂R indications and outcome.

Methods: Patients treated with ECCO₂R in our medial ICU, from March 2014 to November 2017, were retrospectively enrolled. Primary end point was evolution of ventilator settings during the two first days following ECCO₂R start.

Results: Thirty-three patients received ECCO₂R. Seventeen were managed with Hemolung®, 10 with Prismalung®, 4 with ILA®, and 2 with Cardiohelp®. Indications for ECCO₂R were mild or moderate ARDS (n = 16), COPD exacerbation (n = 11), or uncontrolled hypercapnia due to other causes (n = 6). Four patients were not intubated at the time of ECCO₂R start. Median duration of ECCO₂R treatment was 7 days [5-10]. In ARDS patients, between baseline and day 2, median tidal volume and driving pressure decreased from 5.3 [4.4-5.9] mL/kg and 10 [8-15] to 3.8 [3.3-4.1] mL/kg and 9 [8-11], respectively. Prone positioning was performed in 10 of the 16 patients, without serious adverse event. In COPD patients, between baseline and day 2, median ventilation minute and PaCO2 decreased significantly from respectively 7.6 [6.6-8.7] L/min and 9.4 [8.4-10.1] kPa to 5.8 [4.9-6.2] L/min and 6 [5.3-6.8] kPa. Four out of 11 COPD patients were extubated while on ECCO₂R. Device thrombosis occurred in 5 patients (15%). Hemolysis was documented in 16 patients (48%). One patient died of intracranial hemorrhage, while on ECCO₂R. Twenty-four patients were discharged from ICU alive. Twenty-eight day mortality was 31% in ARDS, 9% in COPD patients, and 50% in other causes of refractory hypercapnic respiratory failure.

Conclusion: ECCO₂R was useful to apply ultra-protective ventilation among ARDS patients and improved PaCO₂, pH, and minute ventilation in COPD patients.

Keywords: Acute respiratory distress syndrome; Chronic obstructive pulmonary disease exacerbation; Extracorporeal CO2 removal.