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Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure

Andrea Morelli| Lorenzo Del Sorbo| Antonio Pesenti| V. Marco Ranieri| Eddy Fan
Review
Volume 43, Issue 4 / April , 2017

Pages 519 - 530

Purpose

To review the available knowledge related to the use of ECCO2R as adjuvant strategy to mechanical ventilation (MV) in various clinical settings of acute respiratory failure (ARF).

Methods

Expert opinion and review of the literature.

Results

ECCO2R may be a promising adjuvant therapeutic strategy for the management of patients with severe exacerbations of COPD and for the achievement of protective or ultra-protective ventilation in patients with ARDS without life-threatening hypoxemia. Given the observational nature of most of the available clinical data and differences in technical features and performances of current devices, the balance of risks and benefits for or against ECCO2R in such patient populations remains unclear

Conclusions

ECCO2R is currently an experimental technique rather than an accepted therapeutic strategy in ARF—its safety and efficacy require confirmation in clinical trials.

Keywords

References

  1. Brodie D, Bacchetta M (2011) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–1914
    • View reference on publisher's website
    • View reference on PubMed
  2. Del Sorbo L, Cypel M, Fan E (2014) Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med 2:154–164
    • View reference on publisher's website
    • View reference on PubMed
  3. Cove ME, MacLaren G, Federspiel WJ, Kellum JA (2012) Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care 16(5):232
    • View reference on publisher's website
    • View reference on PubMed
  4. Gattinoni L, Kolobow T, Damia G, Agostoni A, Pesenti A (1979) Extracorporeal carbon dioxide removal (ECCO2R): a new form of respiratory assistance. Int J Artif Organs 4:183–185
  5. Batchinsky AI, Jordan BS, Regn D, Necsoiu C, Federspiel WJ, Morris MJ, Cancio LC (2011) Respiratory dialysis: reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal. Crit Care Med 39:1382–1387
    • View reference on publisher's website
    • View reference on PubMed
  6. Fanelli V, Ranieri MV, Mancebo J et al (2016) Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Crit Care 20:36
    • View reference on publisher's website
    • View reference on PubMed
  7. Del Sorbo L, Pisani L, Filippini C et al (2015) Extracorporeal CO2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med 43:120–127. doi:10.1097/CCM.0000000000000607
    • View reference on publisher's website
    • View reference on PubMed
  8. Gattinoni L, Agostoni A, Pesenti A et al (1980) Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2. Lancet 2:292–294
    • View reference on publisher's website
    • View reference on PubMed
  9. Tajimi K, Kasai T, Nakatani T, Kobayashi K (1988) Extracorporeal lung assist for patient with hypercapnia due to status asthmaticus. Intensive Care Med 14:588–589
  10. Sklar MC, Beloncle F, Katsios CM et al (2015) Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med 41:1752–1762
  11. Schellongowski P, Riss K, Staudinger T et al (2015) Extracorporeal CO2 removal as bridge to lung transplantation in lifethreatening hypercapnia. Transpl Int 28:297–304
    • View reference on publisher's website
    • View reference on PubMed
  12. Tasker RC, Peters MJ (1998) Combined lung injury, meningitis and cerebral edema: how permissive can hypercapnia be? Intensive Care Med 24:616–619
  13. Stengl M, Ledvinova L, Chvojka J et al (2013) Effects of clinically relevant acute hypercapnic and metabolic acidosis on the cardiovascular system: an experimental porcine study. Crit Care 17:R303
    • View reference on publisher's website
    • View reference on PubMed
  14. Ismaiel NM, Henzler D (2011) Effects of hypercapnia and hypercapnic acidosis on attenuation of ventilator-associated lung injury. Minerva Anestesiol 77:723–733
    • View reference on PubMed
  15. Nichol AD, O’Cronin DF, Howell K et al (2009) Infection-induced lung injury is worsened after renal buffering of hypercapnic acidosis. Crit Care Med 37:2953–2961
    • View reference on publisher's website
    • View reference on PubMed
  16. Karagiannidis C, Kampe KA, Sipmann FA et al (2014) Venovenous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations. Critical Care 18(3):1
    • View reference on publisher's website
  17. Morimont P, Batchinsky A, Lambermont B (2015) Update on the role of extracorporeal CO2 removal as an adjunct to mechanical ventilation in ARDS. Crit Care 19:117
    • View reference on publisher's website
    • View reference on PubMed
  18. Camporota L, Barrett N (2016) Current applications for the use of extracorporeal carbon dioxide removal in critically ill patients. Biomed Res Int 2016:9781695
    • View reference on publisher's website
    • View reference on PubMed
  19. Flörchinger B, Philipp A, Klose A et al (2008) Pumpless extracorporeal lung assist: a 10-year institutional experience. Ann Thorac Surg 86:410–417
    • View reference on publisher's website
    • View reference on PubMed
  20. Zanella A, Castagna L, Salerno D, Scaravilli V et al (2015) Respiratory electrodialysis. A novel, highly efficient extracorporeal CO2 removal technique. Am J Respir Crit Care Med 192:719–726
    • View reference on publisher's website
    • View reference on PubMed
  21. Scaravilli V, Kreyer S, Belenkiy S et al (2016) Extracorporeal carbon dioxide removal enhanced by lactic acid infusion in spontaneously breathing conscious sheep. Anesthesiology 124:674–682
    • View reference on publisher's website
    • View reference on PubMed
  22. Slutsky AS, Ranieri MV (2013) Ventilator-induced lung injury. N Engl J Med 22:2126–2136
    • View reference on publisher's website
  23. Terragni PP, Rosboch G, Tealdi A et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166
    • View reference on publisher's website
    • View reference on PubMed
  24. Terragni P, Ranieri VM, Brazzi L (2015) Novel approaches to minimize ventilator-induced lung injury. Curr Opin Crit Care 1:20–25
    • View reference on publisher's website
  25. Bellani G, Guerra L, Musch G, Zanella A, Patroniti N, Mauri T, Messa C, Pesenti A (2011) Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury. Am J Respir Crit Care Med 183:1193–1199
    • View reference on publisher's website
    • View reference on PubMed
  26. Grasso S, Stripoli T, De Michele M et al (2007) ARDSnet ventilator protocol and alveolar hyperinflation: role of positive end-expiratory pressure. Am J Respir Crit Care Med 176:761–767
    • View reference on publisher's website
    • View reference on PubMed
  27. Zapol WM, Snider MT, Hill JD et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196
    • View reference on publisher's website
    • View reference on PubMed
  28. Kolobow T, Gattinoni L, Tomlinson TA, Pierce JE (1977) Control of breathing using an extracorporeal membrane lung. Anesthesiology 46:138–141
    • View reference on publisher's website
    • View reference on PubMed
  29. Gattinoni L, Agostoni A, Pesenti A et al (1980) Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2. Lancet 2:292–294
    • View reference on publisher's website
    • View reference on PubMed
  30. Gattinoni L, Pesenti A, Mascheroni D et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886
    • View reference on publisher's website
    • View reference on PubMed
  31. Barthelemy R, Galletti PM, Trudell LA et al (1982) Total extracorporeal CO2 removal in a pumpless artery-to-vein shunt. Trans Am Soc Artif Intern Organs 28:354–358
    • View reference on PubMed
  32. Bein T, Weber F, Philipp A et al (2006) A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med 34:1372–1377. doi:10.1097/01.CCM.0000215111.85483.BD
    • View reference on publisher's website
    • View reference on PubMed
  33. Terragni PP, Rosboch G, Tealdi A et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166
    • View reference on publisher's website
    • View reference on PubMed
  34. Terragni PP, del Sorbo L, Mascia L et al (2009) Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology 111:826–835. doi:10.1097/ALN.0b013e3181b764d2
    • View reference on publisher's website
    • View reference on PubMed
  35. Bein T, Weber-Carstens S, Goldmann A et al (2013) Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus “conventional” protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med 39:847–856. doi:10.1007/s00134-012-2787-6
  36. Moss CE, Galtrey EJ, Camporota L, Meadows C, Gillon S, Ioannou N, Barrett NA (2016) A retrospective observational case series of low flow veno-venous extracorporeal carbon dioxide removal use in patients with respiratory failure. ASAIO J 62(4):458–462
    • View reference on publisher's website
    • View reference on PubMed
  37. Fitzgerald M, Millar J, Blackwood B, Davies A, Brett SJ, McAuley DF, McNamee JJ (2014) Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Crit Care 18:222
    • View reference on publisher's website
    • View reference on PubMed
  38. Grasso S, Stripoli T, Mazzone P et al (2014) Low respiratory rate plus minimally invasive extracorporeal CO2 removal decreases systemic and pulmonary inflammatory mediators in experimental acute respiratory distress syndrome. Crit Care Med 42:e451–e460. doi:10.1097/CCM.0000000000000312
    • View reference on publisher's website
    • View reference on PubMed
  39. Nava S, Hill N (2009) Non-invasive ventilation in acute respiratory failure. Lancet 374:250–259. doi:10.1016/S0140-6736(09)60496-7
    • View reference on publisher's website
    • View reference on PubMed
  40. Chandra D, Stamm JA, Taylor B et al (2012) Outcomes of noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease in the United States, 1998–2008. Am J Respir Crit Care Med 185:152–159. doi:10.1164/rccm.201106-1094OC
    • View reference on publisher's website
    • View reference on PubMed
  41. Pisani L, Fasano L, Corcione N, Comellini V, Guerrieri A, Ranieri MV, Nava S (2015) Effects of extracorporeal CO2 removal on inspiratory effort and respiratory pattern in patients who fail weaning from mechanical ventilation. Am J Respir Crit Care Med 192:1392–1394. doi:10.1164/rccm.201505-0930LE
    • View reference on publisher's website
    • View reference on PubMed
  42. Kluge S, Braune SA, Engel M et al (2012) Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med 38:1632–1639. doi:10.1007/s00134-012-2649-2
  43. Burki NK, Mani RK, Herth FJF et al (2013) A novel extracorporeal CO2 removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest 143:678–686. doi:10.1378/chest.12-0228
    • View reference on publisher's website
    • View reference on PubMed
  44. Braune S, Sieweke A, Brettner F et al (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 42:1437–1444
  45. Del Sorbo L, Fan E, Nava S, Ranieri VM (2016) ECCO2R in COPD exacerbation only for the right patients and with the right strategy. Intensive Care Med 42(11):1830–1831
  46. Morelli A, D’Egidio A, Orecchioni A, Alessandri F, Mascia L, Ranieri M (2015) Extracorporeal CO2 removal in hypercapnic patients who fail noninvasive ventilation and refuse endotracheal intubation: a case series. Intensive Care Med Exp 3(Suppl 1):A824. doi:10.1186/2197-425X-3-S1-A824
    • View reference on publisher's website
  47. Elliot SC, Paramasivam K, Oram J, Bodenham AR, Howell SJ, Mallick A (2007) Pumpless extracorporeal carbon dioxide removal for life-threatening asthma. Crit Care Med 35:945–948
    • View reference on publisher's website
    • View reference on PubMed
  48. Abrams DC, Brenner K, Burkart KM et al (2013) Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease. Ann Am Thorac Soc 10:307–314. doi:10.1513/AnnalsATS.201301-021OC
    • View reference on publisher's website
    • View reference on PubMed
  49. Roncon-Albuquerque R Jr, Carona G, Neves A, Miranda F, Castelo-Branco S, Oliveira T, Paiva JA (2014) Venovenous extracorporeal CO2 removal for early extubation in COPD exacerbations requiring invasive mechanical ventilation. Intensive Care Med 40:1969–1970
  50. Hermann A, Staudinger T, Bojic A, Riss K, Wohlfarth P, Robak O, Sperr WR, Schellongowski P (2014) First experience with a new miniaturized pump-driven venovenous extracorporeal CO2 removal system (iLA Activve): a retrospective data analysis. ASAIO J 60:342–347
    • View reference on publisher's website
    • View reference on PubMed
  51. Schellongowski P, Riss K, Staudinger T et al (2015) Extracorporeal CO2 removal as bridge to lung transplantation in life threatening hypercapnia. Transplant Int 28:297–304
    • View reference on publisher's website
  52. Collaud S, Benden C, Ganter C, et al. (2016) Extracorporeal life support as bridge to lung retransplantation: a multicenter pooled data analysis. Ann Thorac Surg 102(5):1680–1686
    • View reference on publisher's website
    • View reference on PubMed
  53. Redwan B, Ziegeler S, Semik M, Fichter J, Dickgreber N, Vieth V, Ernst EC, Fischer S (2016) Single-site cannulation veno-venous extracorporeal CO2 removal as bridge to lung volume reduction surgery in end-stage lung emphysema. ASAIO J 62(6):743–746
    • View reference on publisher's website
    • View reference on PubMed
  54. Aurigemma NM, Feldman NT, Gottlieb M, Ingram RH Jr, Lazarus JM, Lowrie EG (1977) Arterial oxygenation during hemodialysis. N Engl J Med 297:871–873
    • View reference on publisher's website
    • View reference on PubMed
  55. Gattinoni L, Kolobow T, Tomlinson T, Iapichino G, Samaja M, White D, Pierce J (1978) Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPVECCO2R): an experimental study. Anesth Analg 57:470–477
    • View reference on publisher's website
    • View reference on PubMed
  56. Gattinoni L (2016) Ultra-protective ventilation and hypoxemia. Crit Care 20(1):130
    • View reference on publisher's website
    • View reference on PubMed
  57. Morimont P, Desaive T, Guiot J et al (2014) Effects of veno-venous CO2 removal therapy on pulmonary circulation in an ARDS model. Intensive Care Med Exp 2:45
    • View reference on publisher's website
  58. Morimont P, Guiot J, T Desaive et al (2015) Veno-venous extracorporeal CO2 removal improves pulmonary hemodynamics in a porcine ARDS model. Acta Anaesthesiol Scand 59:448–456
    • View reference on publisher's website
    • View reference on PubMed
  59. Cherpanath TG, Landburg PP, Lagrand WK, Schultz MJ, Juffermans NP (2015) Effect of extracorporeal CO2 removal on right ventricular and hemodynamic parameters in a patient with acute respiratory distress syndrome. Perfusion 31(6):525–529
    • View reference on publisher's website
    • View reference on PubMed
  60. Karagiannidis C, Strassmann S, Philipp A, Müller T, Windisch W (2015) Veno-venous extracorporeal CO2 removal improves pulmonary hypertension in acute exacerbation of severe COPD. Intensive Care Med 41:1509–1510
  61. Forster C, Schriewer J, John S, Eckardt KU, Willam C (2013) Low-flow CO2 removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements. Crit Care 17:R154
    • View reference on publisher's website
    • View reference on PubMed
  62. Beloncle F, Brochard L (2015) Extracorporeal CO2 removal for chronic obstructive pulmonary disease: too risky or ready for a trial? Crit Care Med 43:245–246
    • View reference on publisher's website
    • View reference on PubMed
  63. Cardenas VJ Jr, Miller L, Lynch JE, Anderson MJ, Zwischenberger JB (2006) Percutaneous venovenous CO2 removal with regional anticoagulation in an ovine model. ASAIO J 52:467–470
    • View reference on publisher's website
    • View reference on PubMed
  64. Murphy DA, Hockings LE, Andrews RK et al (2015) Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev 29(2):90–101
    • View reference on publisher's website
    • View reference on PubMed
  65. Hermann A, Riss K, Schellongowski P et al (2015) A novel pump-driven veno-venous gas exchange system during extracorporeal CO2 removal. Intensive Care Med 41:1773–1780
  66. Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768
    • View reference on publisher's website
    • View reference on PubMed

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