Extracorporeal CO2 removal in severe respiratory acidotic intubated patients: A seven year experience observational study

Abstract

Severe hypercapnia increases the risk of non-protective ventilation and is associated with high mortality in critically ill patients. In this study we assess the use of low-flow extracorporeal CO2 removal (ECCO₂R) integrated into a renal platform and the factors related to patient outcome in a tertiary university hospital. Data from 73 patients with severe respiratory acidosis (pCO₂ > 60 mmHg and Ph < 7.25 for more than 3 h) at risk for ventilator-induced lung injury (VILI), were analysed. The median duration of the therapy was 96 h (IQR 58 to 163). We observed that early use of ECCO₂R (within 6h from meeting treatment criteria) was associated with a significant reduction in mortality (54.5 vs 77.5 %, p = 0.038) and a non-significant reduction in the duration of ECCO₂R therapy, mechanical ventilation days, ICU length of stay and need for tracheostomy. Adverse events were found in 7 % of the patients, with no cases of major bleeding. A significant shorter mean life was observed for larger membranes (1.8 m²) in respect to 0.35 and 0.8 m². We conclude that ECCO₂R integrated into renal platforms is a feasible and safe technique in severe respiratory acidosis when there is risk for VILI.

Keywords: Acidosis; Artificial; Critical care; ECCO(2)R; Extracorporeal membrane oxygenation; Respiration; Respiratory.