title: A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD.
abstract: BACKGROUND
  Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO2 removal (ECCO2R) techniques have not been systematically evaluated in these patients.
  
  
  METHODS
  This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2 removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean.
  
  
  RESULTS
  The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; PaCO2 decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization.
  
  
  CONCLUSIONS
  This single-catheter, low-flow ECCO2R system provided clinically useful levels of CO2 removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure.
authors: University of Connecticut Health Center, Farmington, CT. Electronic address: nburki@uchc.edu.
authors: Nausherwan K
authors: NK
authors: Burki
authors: Artemis Health Sciences, Gurgaon, India.
authors: Raj Kumar
authors: RK
authors: Mani
authors: Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors: Felix J F
authors: FJF
authors: Herth
authors: Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.
authors: Werner
authors: W
authors: Schmidt
authors: Ruhrlandklinik, Essen, Germany.
authors: Helmut
authors: H
authors: Teschler
authors: Ruhrlandklinik, Essen, Germany.
authors: Frank
authors: F
authors: Bonin
authors: Asklepios Klinik Barmbek, Hamburg, Germany.
authors: Heinrich
authors: H
authors: Becker
authors: Institute of Pneumology, Universität Witten/Herdecke, Krankenhaus Bethanien, Solingen, Germany.
authors: Winfried J
authors: WJ
authors: Randerath
authors: Institute of Pneumology, Universität Witten/Herdecke, Krankenhaus Bethanien, Solingen, Germany.
authors: Sven
authors: S
authors: Stieglitz
authors: Institute of Pneumology, Universität Witten/Herdecke, Krankenhaus Bethanien, Solingen, Germany.
authors: Lars
authors: L
authors: Hagmeyer
authors: Institute of Pneumology, Universität Witten/Herdecke, Krankenhaus Bethanien, Solingen, Germany.
authors: Christina
authors: C
authors: Priegnitz
authors: Klinik Donaustauf, Donaustauf, Germany.
authors: Michael
authors: M
authors: Pfeifer
authors: Klinik Donaustauf, Donaustauf, Germany.
authors: Stefan H
authors: SH
authors: Blaas
authors: University of Bonn, Bonn, Germany.
authors: Christian
authors: C
authors: Putensen
authors: University of Bonn, Bonn, Germany.
authors: Nils
authors: N
authors: Theuerkauf
authors: Georg-August-Universität Göttingen, Göttingen, Germany.
authors: Michael
authors: M
authors: Quintel
authors: Georg-August-Universität Göttingen, Göttingen, Germany.
authors: Onnen
authors: O
authors: Moerer
mesh_terms: D000368:Aged; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*