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Table 4 Relevant clinical studies of ECCO2R in ARDS patients

From: The role of hypercapnia in acute respiratory failure

StudyECCO2R techniqueDescription and results
Terragni et al. [56]Modified continuous VV hemofiltration system with membrane lung via a 14-Fr single dual lumen catheter (femoral) with an extracorporeal blood flow of 191–422 mL/minProspective study.Ten ARDS patients with 28 ≤ Pplat ≤ 30 after 72 h of ARDSNet ventilation were placed on ECCO2R and had a progressive reduction in VT.VT was reduced from 6.3 ± 0.2 to 4.2 ± 0.3 mL/kg PBW and Pplat decreased from 29.1 ± 1.2 to 25.0 ± 1.2 cmH2O (P < 0.001).Consequent respiratory acidosis was managed by ECCO2R.Improvement of morphological markers of lung protection and reduction in pulmonary cytokines (P < 0.01) after 72 h of ventilation with VT < 6 mL/kg PBW.No patient-related complications.Membrane clotting in three patients.
Bein et al. [58]Femoral AV pumpless extracorporeal lung assist (PECLA) via a 15-Fr arterial cannula and 17-Fr venous cannula with a mean extracorporeal blood flow of 1.3 L/minRandomized controlled trial.Moderate/severe ARDS after 24-h stabilization period with higher PEEP.Randomized to ECCO2R group with ~ 3 mL/kg PBW ventilation or control group with ~ 6 mL/kg PBW ventilation.There were no significant differences in VFDs at day 28 (10 vs. 9 days, P = 0.78) or day 60 (33 vs. 29, P = 0.47).Post hoc analysis showed that patients with P/F ≤ 150 at randomization in ECCO2R group had a significantly shorter duration of ventilation (VFDs at day 60, 41 vs. 28, P = 0.033).Significantly higher red blood cell transfusion in the PECLA group up to day 10 (3.7 vs. 1.5 units, P < 0.05).
Fanelli et al. [59]VV configuration via a 15.5-Fr single dual lumen catheter (femoral or jugular) with a mean extracorporeal blood flow of 435 mL/minProspective study.Moderate/severe ARDS.VT was reduced from baseline to 4 mL/kg PBW.Low-flow ECCO2R was initiated when pH < 7.25 and PaCO2 > 60 mmHg.ECCO2R was effective in correcting pH and PaCO2.Life-threatening hypoxemia such as prone position and ECMO were necessary in four and two patients, respectively.
Schmidt et al. [69]VV configuration managed with renal replacement platform via a 15.5-Fr single dual lumen catheter (femoral or jugular) with a mean extracorporeal blood flow of 421 mL/minProspective multicenter study.Twenty-two patients with mild/moderate ARDSVT gradually reduced following 2-h run-in time from 6 to 5, 4.5, and 4 mL/kg every 30 min and PEEP adjusted to reach 23 ≤ Pplat ≤ 25 cmH2O.No patients required ECMO.No worsening oxygenation.Low-flow ECCO2R managed by RRT platform easily and safely enabled ultraprotective ventilation.Performance of RRT ECCO2R in severe ARDS patients not known.
Combes et al. (NCT 02282657) [70]VV configuration 15.5 to 19 Fr single dual lumen catheter (femoral or jugular) with three different devices.Prospective multicenter study.Ninety-five patients with moderate ARDS. VT progressively decreased to 4 mL/kg PBW.PEEP adjusted to reach 23 ≤ Pplat ≤ 25 cmH2O.Objective to maintain PaCO2 ± 20% of baseline values obtained at VT 6 mL/kg IBW with pH > 7.30.ECCO2R was able to reduce Pplat from 26 ± 5 cmH2O to 23 ± 3 cmH2O (P < 0.01) in 73% of patients.ECCO2R was able to increase PEEP from 12 ± 4 cmH2O to 14 ± 4 cmH2O (P < 0.01).ECCO2R allowed ∆P reduction from 13 ± 5 to 9 ± 4 cmH2O (P < 0.01).There were no significant changes in pH, PaCO2, and PaO2/FiO2 with VT reduction to 4 mL/kg/IBWECCO2R device length: 5 (3–8 days).Derecruitment/hypoxia (n = 2) that need to increase VT, hemolysis (n = 3). Hemorrhage at the cannula insertion point (n = 4), pneumothorax (n = 1).