By Jonathan Downham on January 28, 2016
"Gavin Denton gives a great breakdown on some of the recent papers on Extra Corporeal Carbon Dioxide Removal. He analyses the papers in some detail. A long post….but worth the time I think. Thanks Gavin...
In patients with chronic obstructive airway disease and hypercapneic acidosis, who are failing non-invasive ventilation, does extra corporeal carbon dioxide removal compared to non-invasive ventilation alone, reduce the need for invasive mechanical ventilation?
Bottom line
- An RCT is required which is adequately powered to detect statistically significant differences in the need for invasive ventilation, mortality and morbidity between groups. A multi-centre (possibly international) trial would be needed to recruit a sufficient number of subjects.
- It is important that future trials compare like for like technology. VV-ECCO2R should be used to compare with IMV to remove the potential confounding increase in complications that may be associated with AV-ECCO2R.
- It is difficult to justify the risks of AV-ECCO2R versus a VV approach. VV-ECCO2R should be the mode of choice, particularly in the context of use outside of the domain of an ECMO centre.
- Patients who receive extracorporeal support should have data submitted to the Extracorporeal Life Support Organisation (ELSO, accessed July 2016). ELSO compiles an international registry of patients who receive extracorporeal life support. This is an organisation that is independent of industry and may be able to provide large volume cohort or case series data in the future.
- Any future research should aim for the greatest independence possible from commercial companies involved in the manufacture of ECCO2R This may require the use of government grants in order to maintain independence from corporate interests.
- There is insufficient evidence to recommend the routine use of ECCO2R in any population. In centres where a system of training and clinical governance is in place, ECCO2R is a potential option in individual cases."