CO2 removal device shows promise for COPD-related respiratory failure
medwireNews: Extracorporeal CO2 removal (ECCO2R) could be an effective treatment for chronic obstructive pulmonary disease (COPD) patients with hypercapnic respiratory failure, pilot results indicate.
The device uses a single venous catheter advanced to the inferior or superior vena cava, and removes significant amounts of CO2 from the blood, returning oxygenated blood. It was fitted in 20 COPD patients with hypercapnic respiratory failure for a mean of 104.2 hours.
Patients were divided into three groups: those with an acute exacerbation of COPD on non-invasive positive pressure ventilation (NIPPV) at very high likelihood (>50%) for requiring intubation and invasive positive pressure ventilation (IPPV) (Group 1; n=7); those requiring NIPPV who had failed two weaning attempts and did not want IPPV (Group 2; n=2); and those who were already on IPPV who had failed two weaning attempts or failed one weaning attempt and did not want to continue with IPPV (Group 3; n=11).
Invasive ventilation was avoided in all patients in group 1, report Nausherwan Burki (University of Connecticut Health Center, Farmington, USA) and colleagues in Chest. Additionally, both patients in group 2 were successfully weaned. Meanwhile, in group 3, only one patient remained on the same level of ventilation as before ECCO2R, with three being weaned completely.
In all, seven patients died within 30 days of discontinuing ECCO2R, including one who died as a direct result of catheter insertion. However, the overall mortality rate of 35% was expected, given the severity of the patients' conditions, the authors say.
ECCO2R was first applied to hypoxic respiratory failure over 30 years ago; however, the technique has never reached widespread use, the authors comment. They say their results suggest the use of the technique could be expanded.
"It may be useful in the treatment of hypercapnic respiratory failure in patients with COPD and, possibly, may have a role in assisting protective ventilation in patients requiring extreme ventilator support, such as [acute respiratory distress syndrome]," they write.
"A larger, prospective study may help to establish the efficacy and safety of the device and its role in the management of respiratory failure."
By Kirsty Oswald, medwireNews Reporter