Extracorporeal carbon dioxide removal for acute hypercapnic respiratory failure

Abstract

In the past, the only treatment of acute exacerbations of obstructive diseases with hypercapnic respiratory failure refractory to medical treatment was invasive mechanical ventilation (IMV). Considerable technical improvements transformed extracorporeal techniques for carbon dioxide removal in an attractive option to avoid worsening respiratory failure and respiratory acidosis, and to potentially prevent or shorten the duration of IMV in patients with exacerbation of COPD and asthma. In this review, we will present a summary of the pathophysiological rationale and evidence of ECCO₂R in patients with severe exacerbations of these pathologies.

Keywords: Asthma; COPD; ECCO2R; Invasive mechanical ventilation; Noninvasive mechanical ventilation.

Fig. 1

ECCO₂R common configurations. a Minimally invasive veno-venous ECCO₂R system with a single venous vascular access through a double-lumen cannula that can be inserted in the internal jugular or femoral vein. b Pumpless arterio-venous ECCO₂R system with the placement of the membrane in the circuit connecting the femoral artery with the contralateral vein. *PaCO₂ values are purely indicative