RT Journal Article SR Electronic T1 Extracorporeal CO2 removal in patients with severe COPD exacerbation failing non invasive ventilation JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP P4748 VO 42 IS Suppl 57 A1 Lara Pisani A1 Luca Fasano A1 Lorenzo Del Sorbo A1 Vito Fanelli A1 Marco Vito Ranieri A1 Stefano Nava YR 2013 UL http://erj.ersjournals.com/content/42/Suppl_57/P4748.abstract AB BACKGROUND. Noninvasive ventilation (NIV) has a success rate of about 75% during an episode of severe hypercapnic respiratory failure in COPD patients. Recently, a new minimally invasive CO2 extracorporeal removal device (ECCO2-R, Decap; Hemodec, Salerno, Italy) consisting of a pump-driven veno-venous hemofiltration system has been developed. The main features of this system are a low extracorporeal blood flow (<500 ml/min), using a small (14-French) double-lumen catheter, and a relatively small infusion rate of heparin.METHODS. 15 COPD patients with severe hypercapnic respiratory failure failing NIV after a trial of 2-4 hrs and meeting the criteria for intubation (i.e.pH < 7.30 and hypercapnia (no changes or increased in the PaCO2 baseline values), respiratory rate > 35 b/min, moderate to severe dyspnea) were enrolled.The average duration of treatment with Decap was 18-24 hours. Intubation was required in 2/15 (13%) patients, and other 2 had procedure related complications (i.e bleeding and obstruction of hemofiltration circuit), but did not require intubation.RESULTS. Decap improved gas exchange vs baseline (pH 7.28±0.06, PaCO2 81±16 mmHg PaO2/FiO2 184±79, RR 29±8 b/min baseline; pH 7.34±0.07,PaCO2 70±19, PaO2/FiO2 169±60, RR 22±6 b/min at 1 hour; pH 7.37±0.07, PaCO2 64±16, PaO2/FiO2 210±85 RR 21±6 b/min after 12 hours).CONCLUSIONS: This study shows that extracorporeal CO2 removal may be applied safely with veno-venous technique needing low blood flow and therefore can be used to avoid intubation in those patients failing a NIV attempt.