Obstructive Lung Diseases |

Extracorporeal CO2 Removal (ECCO2R) in Stable Severe Hypercapnic COPD Patients Nonresponding to Noninvasive Ventilation (NIV): A Pilot Study FREE TO VIEW

Luca Fasano, MD; Marco Ranieri, MD; Lara Pisani, MD; Nadia Corcione, MD; Stefano Nava, MD
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Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Bologna, Italy; Anestesiologia e Rianimazione, Azienda Ospedaliera Città della Salute e della Scienza e di Torino, University of Torino, Torino, Italy; Respiratory and Critical Care Sant'Orsola Hospital, DIMES University of Bologna, Bologna, Italy

Chest. 2015;148(4_MeetingAbstracts):712A. doi:10.1378/chest.2280613
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The primary purpose of this pilot study is to evaluate the effects of ECCO2R in patients with stable hypercapnic COPD in relation to modification of arterial blood gases and respiratory rate.

METHODS: COPD patients with stable hypercapnia (PaCO2 detection of > 55 mmHg in at least two measurements in the last 3 months) and non-responders to chronic NIV (no improvement in hypercapnia after two hours of treatment discontinuation of at least 5 mmHg) were included. Exclusion criteria were: mean arterial pressure less than 60 mm Hg, contraindications to anticoagulation, Body Mass Index > 30 kg/m2, known diagnosis of respiratory disorder of sleep and restrictive diseases, chest deformations and failure to obtain consent. An ECCO2R device (Decap® Smart ;Hemodec, Salerno, Italy), consisting of a pump-driven veno-venous hemofiltration system, was used.The main features of this system are a low extracorporeal blood flow, a small neonatal membrane lung, the use of small (14-French) double-lumen catheters, and a relatively small infusion rate of heparin.

RESULTS: Four severe COPD patients (FEV1= 18%±6 pred), enrolled in an NIV home care program, underwent a 24 hours trial of ECCO2R while admitted to our Respiratory Intensive Care Unit. Baseline Arterial Blood Gases were (pH=7,37±0.01, PaCO2= 72±8 mmHg, PaO2/FiO2= 226±28 and HCO3= 34±2 mmEq). After 1-6 and 24 hrs PaCO2 significantly decreased as follows: 61±8 (1h), 56±4 (6h), 57±5 (24h) (p<0.001), together with respiratory rate (RR) (24±2 baseline, 18±3;16±4;18±3 at 1,6 and 12 hours, respectively p<0.01). Unfortunately this trend was interrupted in only one patient in whom the PaCO2 and RR started to increase around the twelfth hour; in fact we had to interrupt the treatment after 13 hours due to the presence of a clot in the circuit. This was the only minor adverse event we experienced in our study. 2/4 patients returned to baseline spontaneous breathing level of PaCO2 within the first 24 hours of suspension, while the other 2 maintained stable the value withing the following 7 days.

CONCLUSIONS: We have shown that the application of ECCO2R is safe and feasible in stable severe hypercapnic COPD patients non-respondent to chronic NIV.

CLINICAL IMPLICATIONS: This topic is clinically relevant and the approach is innovative. Chronic hypercapnia is a marker of COPD severity and may be associated with a worst prognosis. Therefore, further studies are required to assess the long-term effectiveness of ECCO2R and the "response curve" in time of PaCO2.

DISCLOSURE: The following authors have nothing to disclose: Lara Pisani, Nadia Corcione, luca fasano, marco ranieri, stefano nava

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