Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure

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.

We report our early experience on use, efficacy and safety of the Hemolung in three Australian intensive care units.

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.

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 PCO₂ improved significantly within 6 hours of instituting ECCOR, in conjunction with a significant reduction in minute ventilation. The CO₂ clearance 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.

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.