Low flow extracorporeal CO2 removal in ARDS patients: a prospective short-term crossover pilot study

Harlinde Peperstraete, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, Eric Hoste, Harlinde Peperstraete, Sunny Eloot, Pieter Depuydt, Filip De Somer, Carl Roosens, Eric Hoste

Abstract

Background: Lung protective mechanical ventilation (MV) is the corner stone of therapy for ARDS. However, its use may be limited by respiratory acidosis. This study explored feasibility of, effectiveness and safety of low flow extracorporeal CO2 removal (ECCO2R).

Methods: This was a prospective pilot study, using the Abylcap® (Bellco) ECCO2R, with crossover off-on-off design (2-h blocks) under stable MV settings, and follow up till end of ECCO2R. Primary endpoint for effectiveness was a 20% reduction of PaCO2 after the first 2-h. Adverse events (AE) were recorded prospectively. We included 10 ARDS patients on MV, with PaO2/FiO2 < 150 mmHg, tidal volume ≤ 8 mL/kg with positive end-expiratory pressure ≥ 5 cmH2O, FiO2 titrated to SaO2 88-95%, plateau pressure ≥ 28 cmH2O, and respiratory acidosis (pH <7.25).

Results: After 2-h of ECCO2R, 6 patients had a ≥ 20% decrease in PaCO2 (60%); PaCO2 decreased 28.4% (from 58.4 to 48.7 mmHg, p = 0.005), and pH increased (1.59%, p = 0.005). ECCO2R was hemodynamically well tolerated. During the whole period of ECCO2R, 6 patients had an AE (60%); bleeding occurred in 5 patients (50%) and circuit thrombosis in 3 patients (30%), these were judged not to be life threatening.

Conclusions: In ARDS patients, low flow ECCO2R significantly reduced PaCO2 after 2 h, Follow up during the entire ECCO2R period revealed a high incidence of bleeding and circuit thrombosis.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT01911533" title="See in ClinicalTrials.gov">NCT01911533 , registered 23 July 2013.

Keywords: Acute respiratory distress syndrome; Driving pressure; Extracorporeal carbon dioxide removal; Lung protective mechanical ventilation; Plateau pressure.

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in agreement with the declaration of Helsinki and approved by the Ethics Committee of the Ghent University Hospital (EC 2013/505). Inclusion was only possible after obtaining written informed consent from the patient or the proxy.

Consent for publication

Not applicable.

Competing interests

H. Peperstraete: speaker honoraria for an educational program of Bellco.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Evolution of PaCO2 during the 6-h off-on-off period. a: Evolution of PaCO2 during the first 2-h off period. b: Evolution of PaCO2 during the first 2-h on period. c: Evolution of PaCO2 during the second 2-h off period. d: Evolution of pH during the first 2-h off period. e: Evolution of pH during the first 2-h on period. f: Evolution of pH during the second 2-h off period. This figure was created with Excel (Office)

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