Early Experience of a New Extracorporeal Carbon Dioxide Removal Device for Acute Hypercapnic Respiratory Failure

Crit Care Resusc. 2016 Dec;18(4):261-269.

Abstract

Background: Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation.

Objective: We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units.

Methods: Retrospective review of all patients with acute or acute-on-chronic respiratory failure (due to chronic obstructive pulmonary disease [COPD] with severe hypercapnic respiratory failure when non-invasive ventilation failed; acute respiratory distress syndrome; COPD; or asthma when lung-protective ventilation was not feasible due to hypercapnia) for whom the Hemolung was used.

Results: Fifteen patients were treated with ECCOR. In four out of five patients, the aim of avoiding intubation was achieved. In the remaining 10 patients, the strategy of instituting lung-protective ventilation was successful. The median duration for ECCOR was 5 days (interquartile range, 3-7 days). The pH and PCO2 improved significantly within 6 hours of instituting ECCOR, in conjunction with a significant reduction in minute ventilation. The CO2 clearance was 90-100 mL/min. A total of 93% of patients survived to weaning from ECCOR, 73% survived to ICU discharge and 67% survived to hospital discharge.

Conclusion: Our data shows that ECCOR was safe and effective in this cohort. Further experience is vital to identify the patients who may benefit most from this promising therapy.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Carbon Dioxide
  • Equipment Design
  • Extracorporeal Circulation / instrumentation*
  • Feasibility Studies
  • Humans
  • Hypercapnia / complications
  • Hypercapnia / therapy*
  • Middle Aged
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy*
  • Retrospective Studies
  • Young Adult

Substances

  • Carbon Dioxide