Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 4/2017

01-04-2017 | Review

Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure

Authors: Andrea Morelli, Lorenzo Del Sorbo, Antonio Pesenti, V. Marco Ranieri, Eddy Fan

Published in: Intensive Care Medicine | Issue 4/2017

Login to get access

Purpose

To review the available knowledge related to the use of ECCO2R as adjuvant strategy to mechanical ventilation (MV) in various clinical settings of acute respiratory failure (ARF).

Methods

Expert opinion and review of the literature.

Results

ECCO2R may be a promising adjuvant therapeutic strategy for the management of patients with severe exacerbations of COPD and for the achievement of protective or ultra-protective ventilation in patients with ARDS without life-threatening hypoxemia. Given the observational nature of most of the available clinical data and differences in technical features and performances of current devices, the balance of risks and benefits for or against ECCO2R in such patient populations remains unclear

Conclusions

ECCO2R is currently an experimental technique rather than an accepted therapeutic strategy in ARF—its safety and efficacy require confirmation in clinical trials.
Literature
1.
Brodie D, Bacchetta M (2011) Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med 365:1905–1914CrossRefPubMed
2.
Del Sorbo L, Cypel M, Fan E (2014) Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med 2:154–164CrossRefPubMed
3.
Cove ME, MacLaren G, Federspiel WJ, Kellum JA (2012) Bench to bedside review: extracorporeal carbon dioxide removal, past present and future. Crit Care 16(5):232CrossRefPubMedPubMedCentral
4.
Gattinoni L, Kolobow T, Damia G, Agostoni A, Pesenti A (1979) Extracorporeal carbon dioxide removal (ECCO2R): a new form of respiratory assistance. Int J Artif Organs 4:183–185
5.
Batchinsky AI, Jordan BS, Regn D, Necsoiu C, Federspiel WJ, Morris MJ, Cancio LC (2011) Respiratory dialysis: reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal. Crit Care Med 39:1382–1387CrossRefPubMed
6.
Fanelli V, Ranieri MV, Mancebo J et al (2016) Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Crit Care 20:36CrossRefPubMedPubMedCentral
7.
8.
Gattinoni L, Agostoni A, Pesenti A et al (1980) Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2. Lancet 2:292–294CrossRefPubMed
9.
Tajimi K, Kasai T, Nakatani T, Kobayashi K (1988) Extracorporeal lung assist for patient with hypercapnia due to status asthmaticus. Intensive Care Med 14:588–589CrossRefPubMed
10.
Sklar MC, Beloncle F, Katsios CM et al (2015) Extracorporeal carbon dioxide removal in patients with chronic obstructive pulmonary disease: a systematic review. Intensive Care Med 41:1752–1762CrossRefPubMed
11.
Schellongowski P, Riss K, Staudinger T et al (2015) Extracorporeal CO2 removal as bridge to lung transplantation in lifethreatening hypercapnia. Transpl Int 28:297–304CrossRefPubMed
12.
Tasker RC, Peters MJ (1998) Combined lung injury, meningitis and cerebral edema: how permissive can hypercapnia be? Intensive Care Med 24:616–619CrossRefPubMed
13.
Stengl M, Ledvinova L, Chvojka J et al (2013) Effects of clinically relevant acute hypercapnic and metabolic acidosis on the cardiovascular system: an experimental porcine study. Crit Care 17:R303CrossRefPubMedPubMedCentral
14.
Ismaiel NM, Henzler D (2011) Effects of hypercapnia and hypercapnic acidosis on attenuation of ventilator-associated lung injury. Minerva Anestesiol 77:723–733PubMed
15.
Nichol AD, O’Cronin DF, Howell K et al (2009) Infection-induced lung injury is worsened after renal buffering of hypercapnic acidosis. Crit Care Med 37:2953–2961CrossRefPubMed
16.
Karagiannidis C, Kampe KA, Sipmann FA et al (2014) Venovenous extracorporeal CO2 removal for the treatment of severe respiratory acidosis: pathophysiological and technical considerations. Critical Care 18(3):1CrossRef
17.
Morimont P, Batchinsky A, Lambermont B (2015) Update on the role of extracorporeal CO2 removal as an adjunct to mechanical ventilation in ARDS. Crit Care 19:117CrossRefPubMedPubMedCentral
18.
Camporota L, Barrett N (2016) Current applications for the use of extracorporeal carbon dioxide removal in critically ill patients. Biomed Res Int 2016:9781695CrossRefPubMedPubMedCentral
19.
Flörchinger B, Philipp A, Klose A et al (2008) Pumpless extracorporeal lung assist: a 10-year institutional experience. Ann Thorac Surg 86:410–417CrossRefPubMed
20.
Zanella A, Castagna L, Salerno D, Scaravilli V et al (2015) Respiratory electrodialysis. A novel, highly efficient extracorporeal CO2 removal technique. Am J Respir Crit Care Med 192:719–726CrossRefPubMed
21.
Scaravilli V, Kreyer S, Belenkiy S et al (2016) Extracorporeal carbon dioxide removal enhanced by lactic acid infusion in spontaneously breathing conscious sheep. Anesthesiology 124:674–682CrossRefPubMed
22.
Slutsky AS, Ranieri MV (2013) Ventilator-induced lung injury. N Engl J Med 22:2126–2136CrossRef
23.
Terragni PP, Rosboch G, Tealdi A et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166CrossRefPubMed
24.
Terragni P, Ranieri VM, Brazzi L (2015) Novel approaches to minimize ventilator-induced lung injury. Curr Opin Crit Care 1:20–25CrossRef
25.
Bellani G, Guerra L, Musch G, Zanella A, Patroniti N, Mauri T, Messa C, Pesenti A (2011) Lung regional metabolic activity and gas volume changes induced by tidal ventilation in patients with acute lung injury. Am J Respir Crit Care Med 183:1193–1199CrossRefPubMedPubMedCentral
26.
Grasso S, Stripoli T, De Michele M et al (2007) ARDSnet ventilator protocol and alveolar hyperinflation: role of positive end-expiratory pressure. Am J Respir Crit Care Med 176:761–767CrossRefPubMed
27.
Zapol WM, Snider MT, Hill JD et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA 242:2193–2196CrossRefPubMed
28.
Kolobow T, Gattinoni L, Tomlinson TA, Pierce JE (1977) Control of breathing using an extracorporeal membrane lung. Anesthesiology 46:138–141CrossRefPubMed
29.
Gattinoni L, Agostoni A, Pesenti A et al (1980) Treatment of acute respiratory failure with low-frequency positive-pressure ventilation and extracorporeal removal of CO2. Lancet 2:292–294CrossRefPubMed
30.
Gattinoni L, Pesenti A, Mascheroni D et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886CrossRefPubMed
31.
Barthelemy R, Galletti PM, Trudell LA et al (1982) Total extracorporeal CO2 removal in a pumpless artery-to-vein shunt. Trans Am Soc Artif Intern Organs 28:354–358PubMed
32.
33.
Terragni PP, Rosboch G, Tealdi A et al (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166CrossRefPubMed
34.
35.
Bein T, Weber-Carstens S, Goldmann A et al (2013) Lower tidal volume strategy (≈3 ml/kg) combined with extracorporeal CO2 removal versus “conventional” protective ventilation (6 ml/kg) in severe ARDS: the prospective randomized Xtravent-study. Intensive Care Med 39:847–856. doi:10.​1007/​s00134-012-2787-6 CrossRefPubMedPubMedCentral
36.
Moss CE, Galtrey EJ, Camporota L, Meadows C, Gillon S, Ioannou N, Barrett NA (2016) A retrospective observational case series of low flow veno-venous extracorporeal carbon dioxide removal use in patients with respiratory failure. ASAIO J 62(4):458–462CrossRefPubMed
37.
Fitzgerald M, Millar J, Blackwood B, Davies A, Brett SJ, McAuley DF, McNamee JJ (2014) Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Crit Care 18:222CrossRefPubMedPubMedCentral
38.
Grasso S, Stripoli T, Mazzone P et al (2014) Low respiratory rate plus minimally invasive extracorporeal CO2 removal decreases systemic and pulmonary inflammatory mediators in experimental acute respiratory distress syndrome. Crit Care Med 42:e451–e460. doi:10.​1097/​CCM.​0000000000000312​ CrossRefPubMed
39.
40.
41.
Pisani L, Fasano L, Corcione N, Comellini V, Guerrieri A, Ranieri MV, Nava S (2015) Effects of extracorporeal CO2 removal on inspiratory effort and respiratory pattern in patients who fail weaning from mechanical ventilation. Am J Respir Crit Care Med 192:1392–1394. doi:10.​1164/​rccm.​201505-0930LE CrossRefPubMed
42.
43.
44.
Braune S, Sieweke A, Brettner F et al (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive Care Med 42:1437–1444CrossRefPubMed
45.
Del Sorbo L, Fan E, Nava S, Ranieri VM (2016) ECCO2R in COPD exacerbation only for the right patients and with the right strategy. Intensive Care Med 42(11):1830–1831CrossRefPubMed
46.
Morelli A, D’Egidio A, Orecchioni A, Alessandri F, Mascia L, Ranieri M (2015) Extracorporeal CO2 removal in hypercapnic patients who fail noninvasive ventilation and refuse endotracheal intubation: a case series. Intensive Care Med Exp 3(Suppl 1):A824. doi:10.​1186/​2197-425X-3-S1-A824 CrossRefPubMedCentral
47.
Elliot SC, Paramasivam K, Oram J, Bodenham AR, Howell SJ, Mallick A (2007) Pumpless extracorporeal carbon dioxide removal for life-threatening asthma. Crit Care Med 35:945–948CrossRefPubMed
48.
49.
Roncon-Albuquerque R Jr, Carona G, Neves A, Miranda F, Castelo-Branco S, Oliveira T, Paiva JA (2014) Venovenous extracorporeal CO2 removal for early extubation in COPD exacerbations requiring invasive mechanical ventilation. Intensive Care Med 40:1969–1970CrossRefPubMed
50.
Hermann A, Staudinger T, Bojic A, Riss K, Wohlfarth P, Robak O, Sperr WR, Schellongowski P (2014) First experience with a new miniaturized pump-driven venovenous extracorporeal CO2 removal system (iLA Activve): a retrospective data analysis. ASAIO J 60:342–347CrossRefPubMed
51.
Schellongowski P, Riss K, Staudinger T et al (2015) Extracorporeal CO2 removal as bridge to lung transplantation in life threatening hypercapnia. Transplant Int 28:297–304CrossRef
52.
Collaud S, Benden C, Ganter C, et al. (2016) Extracorporeal life support as bridge to lung retransplantation: a multicenter pooled data analysis. Ann Thorac Surg 102(5):1680–1686CrossRefPubMed
53.
Redwan B, Ziegeler S, Semik M, Fichter J, Dickgreber N, Vieth V, Ernst EC, Fischer S (2016) Single-site cannulation veno-venous extracorporeal CO2 removal as bridge to lung volume reduction surgery in end-stage lung emphysema. ASAIO J 62(6):743–746CrossRefPubMed
54.
Aurigemma NM, Feldman NT, Gottlieb M, Ingram RH Jr, Lazarus JM, Lowrie EG (1977) Arterial oxygenation during hemodialysis. N Engl J Med 297:871–873CrossRefPubMed
55.
Gattinoni L, Kolobow T, Tomlinson T, Iapichino G, Samaja M, White D, Pierce J (1978) Low-frequency positive pressure ventilation with extracorporeal carbon dioxide removal (LFPPVECCO2R): an experimental study. Anesth Analg 57:470–477CrossRefPubMed
56.
57.
Morimont P, Desaive T, Guiot J et al (2014) Effects of veno-venous CO2 removal therapy on pulmonary circulation in an ARDS model. Intensive Care Med Exp 2:45CrossRef
58.
Morimont P, Guiot J, T Desaive et al (2015) Veno-venous extracorporeal CO2 removal improves pulmonary hemodynamics in a porcine ARDS model. Acta Anaesthesiol Scand 59:448–456CrossRefPubMed
59.
Cherpanath TG, Landburg PP, Lagrand WK, Schultz MJ, Juffermans NP (2015) Effect of extracorporeal CO2 removal on right ventricular and hemodynamic parameters in a patient with acute respiratory distress syndrome. Perfusion 31(6):525–529CrossRefPubMed
60.
Karagiannidis C, Strassmann S, Philipp A, Müller T, Windisch W (2015) Veno-venous extracorporeal CO2 removal improves pulmonary hypertension in acute exacerbation of severe COPD. Intensive Care Med 41:1509–1510CrossRefPubMed
61.
Forster C, Schriewer J, John S, Eckardt KU, Willam C (2013) Low-flow CO2 removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor requirements. Crit Care 17:R154CrossRefPubMedPubMedCentral
62.
Beloncle F, Brochard L (2015) Extracorporeal CO2 removal for chronic obstructive pulmonary disease: too risky or ready for a trial? Crit Care Med 43:245–246CrossRefPubMed
63.
Cardenas VJ Jr, Miller L, Lynch JE, Anderson MJ, Zwischenberger JB (2006) Percutaneous venovenous CO2 removal with regional anticoagulation in an ovine model. ASAIO J 52:467–470CrossRefPubMed
64.
Murphy DA, Hockings LE, Andrews RK et al (2015) Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev 29(2):90–101CrossRefPubMed
65.
Hermann A, Riss K, Schellongowski P et al (2015) A novel pump-driven veno-venous gas exchange system during extracorporeal CO2 removal. Intensive Care Med 41:1773–1780CrossRefPubMed
66.
Fuehner T, Kuehn C, Hadem J et al (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185:763–768CrossRefPubMed
Metadata
Title
Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure
Authors
Andrea Morelli
Lorenzo Del Sorbo
Antonio Pesenti
V. Marco Ranieri
Eddy Fan
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 4/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4673-0

Other articles of this Issue 4/2017

Intensive Care Medicine 4/2017 Go to the issue

Review

Sepsis: frontiers in supportive care, organisation and research

Editorial

Will all ARDS patients be receiving mechanical ventilation in 2035? We are not sure

Editorial

Small observational studies and data sharing: fuel for debate and coins for the piggy bank of evidence

Seven-Day Profile Publication

Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial

Imaging in Intensive Care Medicine

Steeple sign and narrowed upper airway in an influenza patient

Correspondence

Effects of neuromuscular blockers on transpulmonary pressures in moderate to severe acute respiratory distress syndrome