Background: Acute exacerbation of chronic obstructive pulmonary disease (ae-COPD) has a gold standard treatment: non-invasive ventilation (NIV). However, this treatment sometime fails, and an invasive mechanical ventilation (IMV) is required. The extracorporeal CO₂ removal (ECCO₂R) device can be an alternative to intubation. The aim of the study is to evaluate ECCO₂R efficiency and safety and enlighten ECCO₂R benefit/risk compared to IMV.
Methods: Consecutive ae-COPD patients for whom NIV failed were retrospectively analyzed during two periods: before and after the ECCO₂R device implementation in our ICU in 2015. We considered the before period as standard of care and patients were treated with IMV. The ECCO₂R device was a pump-driven veno-venous system (Xenios AG).
Results: The two groups (ECCO₂R n = 26 and Control group n = 25) were comparable at baseline except for the BMI which was significantly higher in the ECCO₂R group (30kg/m² versus 25kg/m²). The pH and PaCO₂ improved significantly in both groups. The mean time on ECCO₂R was 5,4 days whereas IMV lasted 27 days in the control group. Four patients needed IMV in the ECCO₂R group (of which 3 occurred after ECCO₂R weaning). There were 7 major bleeding events with ECCO₂R and 3 led to premature termination of ECCO₂R. In the control group, there were 8 ventilator associated pneumonia, 25 haemodynamic instability and 6 self extubations. The mean time in ICU and hospital stay in the ECCO₂R and control groups were 18 vs 30 days, 29 vs 49 days, respectively and the 90-day mortality rates were 15% vs 28%.
Conclusions: ECCO₂R brings significant improvement on pH and PaCO₂ in ae-COPD patients failing NIV therapy and permit to avoid intubation in 85% with low complication rates compared to IMV. These results have yet to be proven in a larger randomized study.
Trial registration: ClinicalTrials.gov, NCT04882410. Date of registration May 12th 2021, Retrospectively registered.
https://www.clinicaltrials.gov/ct2/show/NCT04882410