Section 3 Special Applications

*Advances in Extracorporeal Membrane Oxygenation - Volume 3*

Journal of Thoracic and Cardiovascular

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2014;**29**:906-911

**88**

**91**

**Chapter 6**

Diseases

**Abstract**

Extracorporeal Carbon Dioxide

Removal for the Exacerbation of

*Luis Morales-Quinteros and Antonio Artigas*

Chronic Hypercapnic Respiratory

In the past, treatment of acute exacerbations of obstructive disease refractory to medical treatment was invasive mechanical ventilation. As a result of technical improvements, extracorporeal techniques for carbon dioxide removal have aroused as an attractive option to avoid worsening respiratory failure and respiratory acidosis and potentially prevent, shorten the duration of invasive mechanical ventilation (IMV), and serve as rescue therapy in patients with exacerbation of COPD and asthma. In this review, we will present a comprehensive summary of the pathophysiological rationale and evidence of ECCO2R in patients with severe exacerbations of these pathologies.

Patients with obstructive lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), may experience acute exacerbations with severe hypercapnic respiratory failure. Hypercapnia results from acute worsening of expiratory flow limitation caused by the increased small airway resistance with consequent development of dynamic alveolar hyperinflation and intrinsic PEEP. In the most severe cases, these may be refractory to conventional therapies and mechanical

Extracorporeal carbon dioxide removal (ECCO2R) represents an attractive

The last decade has seen an increasing interest in the provision of extracorporeal support for respiratory failure, as demonstrated by the progressively increasing number of scientific publications on this topic. In particular, remarkable interest has been focused on ECCO2R, due to the relative ease and efficiency in blood CO2 clearance granted by extracorporeal gas exchangers as compared to oxygen delivery (**Table 1**). In recent years, new-generation ECCO2R devices have been developed. More efficient veno-venous (VV-ECCO2R) devices have become available and have replaced the arteriovenous approach, having the advantage of not requiring arterial puncture. They offer lower resistance to blood flow, have small priming volumes, and have a much more efficient gas exchange [1] with relatively low extracorporeal blood flows

**Keywords:** COPD, asthma, ECCO2R, invasive mechanical ventilation,

noninvasive mechanical ventilation

ventilation, becoming life-threatening.

approach in this setting.

**1. Introduction**
