RT Journal Article SR Electronic T1 Extracorporeal CO2 removal in acute exacerbation of COPD unresponsive to non-invasive ventilation JF BMJ Open Respiratory Research JO BMJ Open Resp Res FD British Thoracic Society SP e001089 DO 10.1136/bmjresp-2021-001089 VO 8 IS 1 A1 Mathilde Azzi A1 Jerome Aboab A1 Sophie Alviset A1 Daria Ushmorova A1 Luis Ferreira A1 Vincent Ioos A1 Nathalie Memain A1 Tazime Issoufaly A1 Mathilde Lermuzeaux A1 Laurent Laine A1 Rita Serbouti A1 Daniel Silva YR 2021 UL http://bmjopenrespres.bmj.com/content/8/1/e001089.abstract AB Background The gold-standard treatment for acute exacerbation of chronic obstructive pulmonary disease (ae-COPD) is non-invasive ventilation (NIV). However, NIV failures may be observed, and invasive mechanical ventilation (IMV) is required. Extracorporeal CO₂ removal (ECCO₂R) devices can be an alternative to intubation. The aim of the study was to assess ECCO₂R effectiveness and safety.Methods Patients with consecutive ae-COPD who experienced NIV failure were retrospectively assessed over two periods of time: before and after ECCO₂R device implementation in our ICU in 2015 (Xenios AG).Results Both groups (ECCO₂R: n=26, control group: n=25) were comparable at baseline, except for BMI, which was significantly higher in the ECCO₂R group (30 kg/m² vs 25 kg/m²). pH and PaCO₂ significantly improved in both groups. The mean time on ECCO₂R was 5.4 days versus 27 days for IMV in the control group. Four patients required IMV in the ECCO₂R group, of whom three received IMV after ECCO₂R weaning. Seven major bleeding events were observed with ECCO₂R, but only three led to premature discontinuation of ECCO₂R. Eight cases of ventilator-associated pneumonia were observed in the control group. Mean time spent in the ICU and mean hospital stay in the ECCO₂R and control groups were, respectively, 18 vs 30 days, 29 vs 49 days, and the 90-day mortality rates were 15% vs 28%.Conclusions ECCO₂R was associated with significant improvement of pH and PaCO₂ in patients with ae-COPD failing NIV therapy. It also led to avoiding intubation in 85% of cases, with low complication rates.Trial registration number ClinicalTrials.gov, NCT04882410. Date of registration 12 May 2021, retrospectively registered.https://www.clinicaltrials.gov/ct2/show/NCT04882410.No data are available.