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Table 2 Relevant clinical studies on ECCO2R in COPD

From: The use of extracorporeal CO2 removal in acute respiratory failure

Studies

Type

Number of patients

Characteristics of ECCO2R

Duration of ECCO2R

Main results

Configuration

Blood flow (mL/min)

Fresh gas flow (L/min)

Membrane surface (m2)

ECCO2R with mixed indications

 Burki et al.

Pilot study

20

VV configuration via a 15.5-Fr double-lumen catheter (femoral or jugular)

430

Not reported

PLP based on siloxane layer; 0.59 (ALung Hemolung RAS)

2–192 h

An ECCO2R was implanted in 20 patients with hypercapnic COPD in three distinct groups: group 1 (n = 7) patients under NIV with a high risk of MV; group 2 (n = 2) patients who could not be weaned from NIV; and group 3 (n = 11) patients under MV without possible weaning. MV was avoided in all patients in group 1

Both patients in group 2 were weaned off of NIV

In group 3, three patients were weaned from MV and MV could be reduced in two patients. One patient died from retroperitoneal hemorrhage (during cannulation)

ECCO2R to avoid mechanical ventilation

 Del Sorbo et al.

Paired cohort study with historical control

25

Continuous VV hemofiltration system modified by a pulmonary membrane via a 14-Fr double-femoral cannula (femoral)

255

8

PLP; 1.35 (Hemodec DecapSmart®)

1–2 h

Significantly higher risk of intubation in the NIV-only group (HR 0.27, 95% CI 0.07–0.98). Thirteen patients experienced adverse events: 3 bleeding, 1 venous perforation and 9 device malfunctions

 Braune et al.

Case–control study

25

VV configuration via a single double-lumen cannula of 22 or 24 Fr (femoral or jugular)

1300

Not reported

PMP; 1.3 (Novalung iLA activve)

8.5 h

Intubation was avoided in 14 of 25 patients under ECCO2R (56%). Seven patients under ECCO2R were intubated due to progressive hypoxemia and four due to ventilatory failure despite ECCO2R and NIV. Nine patients under ECCO2R (36%) had major bleeding complications. The 90-day mortality was 28% vs 28%

 Morelli et al.

Retrospective study

30

VV configuration via a 13-Fr catheter (femoral or jugular)

250–450

Not reported

Not reported

2–16 h

Thirty patients with acute hypercapnic respiratory failure due to exacerbation of COPD who refused endotracheal intubation after the failure of NIV

It was possible to avoid endotracheal intubation in 27 patients

 Kluge et al.

Retrospective study

21

Arteriovenous femoral with arterial cannula of 13 to 15 Fr and venous cannula from 13 to 17 Fr

1100

Not reported

PMP; 1.3 (iLA®)

9 h

Nineteen (90%) patients in the PECLA group did not need intubation

No significant difference in 28-day mortality (24 vs. 19%, p = 0.85), 6-month mortality (33 vs. 33%), or length of hospital stay (23 vs 42 days, p = 0.06)

Much less tracheostomy in the PECLA group (10 vs. 67%, p = 0.004)

Two major bleeds and seven minor bleeds in the PECLA group

ECCO2R to wean from mechanical ventilation

 Abrams et al.

Pilot prospective study

5

VV configuration via a 20–24 Fr double-lumen jugular catheter using a lower flow rate on the ECMO system

1700

1–7

PMP; 0.98 (Maquet PALP CardioHelp)

8 h

The mean time (± SD) until ambulation after the start of ECCO2R was 29.4 ± 12.6 h

Four patients were sent home and one received a lung transplant. Only two minor bleeding complications

 Roncon-Albuquerque Jr et al.

Case series

2

VV configuration via a dual-lumen 19-Fr cannula (Avalon Elite®)

700–1000

2–12

PMP, 0.8 (Maquest Quadrox –i pediatric)

7–8 h

ECCO2R was effective in exacerbations of COPD requiring MV, allowing the correction of acute respiratory acidosis, early extubation after 72 h, and early mobilization at day 6. No device-related complications were observed

 Hermann et al.

Retrospective study

12

VV configuration via a single double-lumen 22 or 24-Fr cannula (femoral or jugular)

900–2100

2–12

PMP; 1.3 (Novalung iLA activve)

2–30 h

The indication for ECCO2R was hypercapnia due to terminal pulmonary insufficiency awaiting lung transplantation, pneumonia and COPD or severe acute asthma

ECCO2R allowed efficient decarboxylation, leading to a reduction in ventilation pressures and facilitating spontaneous respiration. Five patients were weaned from VM and extubated under ECCO2R

 Elliot et al.

Case series

2

Arteriovenous configuration without femoro-femoral pump

1400–1600

10–15

PMP; 1.3 (iLA®)

4 h

A 74-year-old man and a 52-year-old woman with severe life-threatening asthma who developed progressive hypercapnia and severe acidosis refractory to all other treatments. The addition of a pumpless ECCO2R to the MV corrected hypercapnia and secondary acidosis and reduced other support measures, including hemodynamics and weaning from MV

  1. ECCO2R extracorporeal carbon dioxide removal, PMP poly-4-methyl-1-pentene, PLP polypropylene, PECLA pumpless extracorporeal lung assist