Use of Extracorporeal CO2 Removal to Avoid Invasive Mechanical Ventilation in Hypercapnic Coma and Failure of Noninvasive Ventilation

Invasive mechanical ventilation is known to be detrimental to patients with respiratory failure due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD). If hypercapnic respiratory failure and acidosis cannot be controlled by noninvasive mechanical ventilation, extracorporeal carbon dioxide removal (ECCO2 R) serves as an alternative option. Currently applied systems like extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (PECLA) are associated with potentially significant bleeding complications and require a very high nursing standard. We report a case of AECOPD with hypercapnic coma and failure of noninvasive ventilation for which we used a novel low-flow ECCO2 R device, called the Hemolung Respiratory Assist System. This device requires only a single 15.5 French double-lumen venous catheter and operates at blood flows of 350 mL/min to 550 mL/min. Use of this device enabled the patient to avoid general anesthesia and invasive mechanical ventilation without adverse events. In addition, weaning from noninvasive mechanical ventilation, early mobilization, communication and nutrition were facilitated. CO2 removal with low extracorporeal blood flow avoided intubation in the treatment of hypercapnic coma with failure of non-invasive ventilation.