title: Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure.
abstract: BACKGROUND
  Recent advances in the technology of extracorporeal respiratory assist systems have led to a renewed interest in extracorporeal carbon dioxide removal (ECCOR). The Hemolung is a new, low-flow, venovenous, minimally invasive, partial ECCOR device that has recently been introduced to clinical practice to aid in avoiding invasive ventilation or to facilitate lung-protective ventilation.
  
  
  OBJECTIVE
  We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units.
  
  
  METHODS
  Retrospective review of all patients with acute or acute-on-chronic respiratory failure (due to chronic obstructive pulmonary disease [COPD] with severe hypercapnic respiratory failure when non-invasive ventilation failed; acute respiratory distress syndrome; COPD; or asthma when lung-protective ventilation was not feasible due to hypercapnia) for whom the Hemolung was used.
  
  
  RESULTS
  Fifteen patients were treated with ECCOR. In four out of five patients, the aim of avoiding intubation was achieved. In the remaining 10 patients, the strategy of instituting lung-protective ventilation was successful. The median duration for ECCOR was 5 days (interquartile range, 3-7 days). The pH and PCO2improved significantly within 6 hours of instituting ECCOR, in conjunction with a significant reduction in minute ventilation. The CO2clearance was 90-100 mL/min. A total of 93% of patients survived to weaning from ECCOR, 73% survived to ICU discharge and 67% survived to hospital discharge.
  
  
  CONCLUSIONS
  Our data shows that ECCOR was safe and effective in this cohort. Further experience is vital to identify the patients who may benefit most from this promising therapy.
authors.affiliation: Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia. travindranath@hotmail.com.
authors.forename: Ravindranath
authors.initials: R
authors.lastname: Tiruvoipati
authors.affiliation: Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Hergen
authors.initials: H
authors.lastname: Buscher
authors.affiliation: Department of Intensive Care Medicine, Gold Coast University Hospital, Gold Coast, Brisbane, QLD, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Winearls
authors.affiliation: Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Breeding
authors.affiliation: Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, Australia.
authors.forename: Debasish
authors.initials: D
authors.lastname: Ghosh
authors.affiliation: Department of Intensive Care Medicine, Gold Coast University Hospital, Gold Coast, Brisbane, QLD, Australia.
authors.forename: Shimonti
authors.initials: S
authors.lastname: Chaterjee
authors.affiliation: Department of Respiratory Medicine, Frankston Hospital, Melbourne, VIC, Australia.
authors.forename: Gary
authors.initials: G
authors.lastname: Braun
authors.affiliation: School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Critical Care Research Group, Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Fraser
authors.affiliation: Department of Intensive Care Medicine, Frankston Hospital, Melbourne, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Botha
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000295:instrumentation*; D005240:Feasibility Studies; D006801:Humans; D006935:Hypercapnia / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide