ECCO₂R, a french national survey

Introduction

ECCO₂R (extracorporeal dioxide carbon removal) is an extracorporeal decarboxylation technology described in 1978¹. Physiological studies showed that 50% of produced CO2 were eliminated². Potential indications are: ultra-protective mechanical ventilation (MV) for acute respiratory distress syndrome (ARDS)³ and hypercapnic patients at risk of failure of noninvasive ventilation (NIV)⁴. Because of the lack of scientific evidence, ECCO2R is not available in the USA. Several trials are currently conducted in Europe.

Objectives

To assess the use of ECCO2R in France.

Methods

This retrospective, observational study was performed in French intensive care units (ICUs) from January 2010 to January 2015. A phone interview was conducted with French ICUs affiliated to national societies and public and private hospitals registries. Data recorded were the following: use and indications of ECCO₂R, type of ECCO₂R, number of treated patients during the study period, complications associated with the technique, satisfaction rates (in term of efficacy, tolerance and global) based on a scale (0 to 10), and concomitant use of ECMO in the unit.

Results

222 French ICUs were contacted (52 medical, 20 surgical, 132 polyvalent, 3 cardio-thoracic, 6 paediatric and 2 neurosurgical ICU). Only 3 refused to participate. Thirty-three (15%) ICU had used ECCO₂R at least once in the past five years, in 292 patients. Most frequent devices used were: iLA^® (Novalung) (63%) and Hemolung^® (Alung) (36%). The median number per ICU of treated patients was 3[1-7]. The most frequent indication was ultra-protective ventilation for ADRS (54%). Other indications were: failure of NIV during COPD exacerbation (30%), weaning from invasive MV in COPD patients (12%) and miscellaneous (4%). Among ICUs using ECCO₂R, 22 (67%) reported at least one complication. The most frequent complications were bleeding (45%) and membrane failure (18%). Satisfaction rates were: in term of decarboxylation 7.9 ± 2.4; tolerance 6.9 ± 2.6; overall satisfaction 6.8 ± 2.2. Twenty-one (63%) of the 33 ICUs using ECCO₂R, also used ECMO. The main reasons for not using ECCO₂R were the lack of trained staff, unavailability of the device and the lack of scientific evidence (in respectively 56.5%, 38% and 19%).

Conclusions

These preliminary results show that ECCO₂R is not widely used in French ICUs. The lack of strong scientific data on outcome is probably the main reason behind the limited use of ECCO₂R. French studies currently in progress will help define indications of ECCO₂R and impact on outcome.