Thursday, April 11, 2019

Extracorporeal CO2 removal

PulmCrit (EMCrit)
PulmCrit - April 8, 2019 - By Josh Farkas 
  • "Permissive hypercapnia is a cornerstone of mechanical ventilation in difficult-to-ventilate patients (e.g. ARDS, asthma). However, the optimal degree of permissive hypercapnia is unknown (e.g. the safe pH range).
  • Intravenous bicarbonate can be used to avoid severe acidemia in the context of permissive hypercapnia. This was utilized in the landmark ARDSnet trial and seems reasonable, but it too remains untested by rigorous trials.
  • Extracorporeal CO2 removal is effective at decreasing CO2 levels, and thereby facilitating more gentle ventilation. However, in the absence of any clear therapeutic targets (regarding pH or pCO2), it’s unclear where this technology might fit in our therapeutic armamentarium.
  • Available evidence regarding extracorporeal CO2 removal has failed to show benefit, but has demonstrated potential harms (e.g. increased risk of bleeding, including intracranial hemorrhage). Given that this technology is expensive and invasive, widespread incorporation should await evidence of benefit in RCTs."