Extracorporeal Carbon Dioxide Removal in Severe Chronic Obstructive Pulmonary Disease Exacerbation

Evaluation of Clinical Effectiveness of ECCO2R for the Treatment of Patients With Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease

The conventional treatment for Severe acute exacerbation of Chronic obstructive pulmonary disease including noninvasive respiratory support, invasive respiratory support, etc, but there are many kinds of limitations and complications. Extracorporeal Carbon Dioxide Removal is a life support technology, which can effectively remove CO2. Recently some clinical studies have showed that ECCO2R can effectively improve the AECOPD patient's respiratory failure, avoid intubation and removal of endotracheal intubation. We performed a study to evaluate the clinical effectiveness of ECCO2R in the treatment of AECOPD patients.

With the development of technology, ECCO2R is not difficult to implement in intensive care unit. Many recently clinical studies have showed that ECCO2R can effectively remove CO2, reduce patient breathing work, improve the patient respiratory failure, and avoid endotracheal intubation. But there are also treated failure and high incidence of complications such as bleeding in the AECOPD patients with ECCO2R treatment, and the treatment related to airway management are less mentioned. Therefore, we set a more strict inclusion criteria in AECOPD patients and evaluate the clinical effectiveness and associated risk of ECCO2R in the treatment of AECOPD.

Inclusion Criteria:

• NPPV treatment failure:

  1. deterioration or no improvement after treatment with NPPV, pH < 7.25, PaCO2 > 70mmHg
  2. Obvious respiratory distress, RR > 30 times/min
  3. Breathing extreme fatigue

Exclusion Criteria:

• Older than 75 years
• endotracheal intubation or tracheostomy
• obviously a lot of pus yellow phlegm, expectorate difficult
• Chest CT: obviously a wide range of consolidation
• BMI < 20 kg/m2,
• Dysfunction of other organ of extrapulmonary
• serious hemodynamic instability
• severe hypoxemia, PaO2 / FiO2 < 100mmHg
• home noninvasive positive pressure ventilation for a long time
• lung fungal infection
• contraindication of anticoagulation
• Platelet < 80000 per cubic millimeter
• Serum creatinine > 200 umol/L
• cardiac arrest
• Hospice care
• Refused to take part in the study