RATIONALE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes. OBJECTIVES: We assessed the feasibility of achieving early extubation and ambulation in subjects requiring IMV for exacerbations of COPD using single-site ECCO₂R. METHODS: Five subjects with exacerbations of COPD with uncompensated hypercapnia requiring IMV were enrolled in this single-center, prospective, feasibility trial using a protocol of ECCO₂R, extubation, and physical rehabilitation. The primary endpoint was extubation within 72 hours of starting ECCO₂R. MEASUREMENTS AND MAIN RESULTS: Mean preintubation pH and PaCO₂ were 7.23 ± 0.05 and 81.6 ± 15.9 mm Hg, respectively. All subjects met the primary endpoint (median duration, 4 h; range, 1.5-21.5 h). Mean duration of extracorporeal support was 193.0 ± 76.5 hours. Mean time to ambulation after extracorporeal initiation was 29.4 ± 12.6 hours. Mean maximal ambulation on extracorporeal support was 302 feet (range, 70-600). Four subjects were discharged home, and one underwent planned lung transplantation. Two minor bleeding complications occurred. There were no complications from mobilization on extracorporeal support. CONCLUSIONS: ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.
RATIONALE: Acute exacerbations of chronic obstructive pulmonary disease (COPD) requiring invasive mechanical ventilation (IMV) are associated with significant morbidity and mortality. Extracorporeal carbon dioxide removal (ECCO₂R) may facilitate extubation and ambulation in these patients and potentially improve outcomes. OBJECTIVES: We assessed the feasibility of achieving early extubation and ambulation in subjects requiring IMV for exacerbations of COPD using single-site ECCO₂R. METHODS: Five subjects with exacerbations of COPD with uncompensated hypercapnia requiring IMV were enrolled in this single-center, prospective, feasibility trial using a protocol of ECCO₂R, extubation, and physical rehabilitation. The primary endpoint was extubation within 72 hours of starting ECCO₂R. MEASUREMENTS AND MAIN RESULTS: Mean preintubation pH and PaCO₂ were 7.23 ± 0.05 and 81.6 ± 15.9 mm Hg, respectively. All subjects met the primary endpoint (median duration, 4 h; range, 1.5-21.5 h). Mean duration of extracorporeal support was 193.0 ± 76.5 hours. Mean time to ambulation after extracorporeal initiation was 29.4 ± 12.6 hours. Mean maximal ambulation on extracorporeal support was 302 feet (range, 70-600). Four subjects were discharged home, and one underwent planned lung transplantation. Two minor bleeding complications occurred. There were no complications from mobilization on extracorporeal support. CONCLUSIONS: ECCO₂R facilitates early extubation and ambulation in exacerbations of COPD requiring IMV and has the potential to serve as a new paradigm for the management of a select group of patients. Rigorous clinical trials are needed to corroborate these results and to investigate the effect on long-term outcomes and cost effectiveness over conventional management.
Authors: Bindu Akkanti; Keshava Rajagopal; Kirti P Patel; Sangeeta Aravind; Emmanuel Nunez-Centanu; Rahat Hussain; Farshad Raissi Shabari; Wayne L Hofstetter; Ara A Vaporciyan; Igor S Banjac; Biswajit Kar; Igor D Gregoric; Pranav Loyalka Journal: J Extra Corpor Technol Date: 2017-06
Authors: Alexander Hermann; Katharina Riss; Peter Schellongowski; Andja Bojic; Philipp Wohlfarth; Oliver Robak; Wolfgang R Sperr; Thomas Staudinger Journal: Intensive Care Med Date: 2015-07-14 Impact factor: 17.440
Authors: F Seiler; F C Trudzinski; M Kredel; C Lotz; P M Lepper; R M Muellenbach Journal: Med Klin Intensivmed Notfmed Date: 2017-07-13 Impact factor: 0.840
Authors: Christian Karagiannidis; Stephan Strassmann; Alois Philipp; Thomas Müller; Wolfram Windisch Journal: Intensive Care Med Date: 2015-06-23 Impact factor: 17.440