Extracorporeal carbon dioxide removal for refractory status asthmaticus: experience in distinct exacerbation phenotypes

Abstract

Extracorporeal carbon dioxide removal (ECCO2R) may be indicated for refractory status asthmaticus when severe dynamic hyperinflation or life-threatening respiratory acidosis persists despite optimal medical and ventilator management. Most prior reports describe the application of ECCO2R to rapid-onset asthma exacerbation, requiring a short duration of extracorporeal support. We report two patients with refractory status asthmaticus managed with ECCO2R, emphasizing the use of modern extracorporeal technology, cannulation technique and management protocols, which may improve the risk-to-benefit profile of this strategy. This report highlights the challenges in managing patients with distinct asthma exacerbation phenotypes. The potential need for prolonged device support may alter provider expectations and offers a new perspective of the role of ECCO2R for status asthmaticus.

Novel Uses of Extracorporeal Membrane Oxygenation in Adults

“…Data from small studies are promising, but larger randomized trials compared with conventional mechanical ventilation are necessary for chronic obstructive pulmonary disease, as well as status asthmaticus and other causes of hypercapnic respiratory failure. 35,36 Patients with acute hypercapnic respiratory failure are well-suited for extracorporeal support because of the efficiency with which EC-CO 2 R ameliorates hypercapnia and respiratory acidosis. A subset of patients with ECCO 2 R-supported hypercapnic respiratory failure may be appropriate candidates for removal of invasive mechanical ventilation.…”

ECMO for Adult Respiratory Failure

“…[76][77][78][79][80] The acute hypercapnia-mediated respiratory acidosis in status asthmaticus is associated with dynamic hyperinflation and high levels of intrinsic PEEP which may result in pneumothorax, hemodynamic compromise, or death. [76][77][78][79][80] The acute hypercapnia-mediated respiratory acidosis in status asthmaticus is associated with dynamic hyperinflation and high levels of intrinsic PEEP which may result in pneumothorax, hemodynamic compromise, or death.…”

The use of life-saving extracorporeal membrane oxygenation (ECMO) for pregnant woman with status asthmaticus

“…Reports on the use of veno-venous membrane oxygenation (ECMO) for status asthmaticus are limited, however it seems to be a life-saving therapeutic option for those who were unresponsive to pharmacological treatment and ventilatory support [2][3][4][5][6][7][8][9][10][11][12][13].…”