Extracorporeal Support for Chronic Obstructive Pulmonary Disease: A Bright Future

Trahanas, John M.; Lynch, William R.; Bartlett, Robert H.

doi:10.1177/0885066616663119

Cited by 12 publications

(9 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Having the hypercapnia managed with ECCO 2 R, she had the chance to express her wishes and have a peaceful death. In this case, as reported in a few cases before (15)(16)(17), the ECCO 2 R system was a successful means to gain time in a difficult situation. Even though it is extremely difficult to design a valid study to investigate the use of ECCO 2 R in this setting, further investigations are needed to see if it could possibly become a valid management strategy for conditions involving exacerbations of chronic type II respiratory failure conditions.…”

Section: Discussionsupporting

confidence: 71%

ECCO2R as a bridge to a decision in type II respiratory failure

Grauslytė

Cerda

Jovaiša

2019

AML

View full text Add to dashboard Cite

Introduction. End-of-life decisions are often time consuming and difficult for everyone involved. In some of these cases extracorporeal life support systems could potentially be used not only as a bridge to treatment but as a tool to buy time to allow patient’s participation in decision making and to avoid further futile invasive procedures. Case report. A previously healthy 53-year-old female patient presented with respiratory failure of unknown cause. In the course of treatment her condition was deemed irreversible and the only option for any chance of long-term survival was a lung transplant. During this whole time the patient’s condition was managed with extracorporeal carbon dioxide removal system (ECCO2R). She remained compos mentis and expressed the wish to stop all the treatment as the option of lung transplant was not acceptable to her. Treatment was withdrawn and she passed away. Discussion. In cases of end-of-life decisions, time can play an essential role. Even though extracorporeal life support systems have been conceptualised to be a bridge to treatment, they could be beneficial in a situation when time is needed to make a decision. ECCO2R has been used as a treatment method in different settings, however, in this case it served as a tool to maintain the patient alive and conscious for a sufficient time for her to participate in decision making. Conclusions. Our case report demonstrated that ECCO2R could serve as a bridge to decision in situations when time is limited and the decisions that need to be made are difficult.

show abstract

Section: Discussionsupporting

confidence: 71%

ECCO2R as a bridge to a decision in type II respiratory failure

Grauslytė

Cerda

Jovaiša

2019

AML

View full text Add to dashboard Cite

show abstract

“…The CO 2 removal target must therefore be reported as a percentage of the rate of metabolically produced CO 2 or the pCO 2 of the blood entering the device must be specified. Trahanas et al provide a review of studies since 2009 of ECCO 2 R used in hypercapnic COPD patients and CO 2 removal rates ranged from 80 to 160 mL/min [ 32 ]. From this, the authors proposed that an ambulatory ECCO 2 R device must remove at least half of the metabolic CO 2 .…”

Section: Discussionmentioning

confidence: 99%

Bench Validation of a Compact Low-Flow CO2 Removal Device

May

Jeffries

Frankowski

et al. 2018

ICMx

View full text Add to dashboard Cite

BackgroundThere is increasing evidence demonstrating the value of partial extracorporeal CO2 removal (ECCO2R) for the treatment of hypercapnia in patients with acute exacerbations of chronic obstructive pulmonary disease and acute respiratory distress syndrome. Mechanical ventilation has traditionally been used to treat hypercapnia in these patients, however, it has been well-established that aggressive ventilator settings can lead to ventilator-induced lung injury. ECCO2R removes CO2 independently of the lungs and has been used to permit lung protective ventilation to prevent ventilator-induced lung injury, prevent intubation, and aid in ventilator weaning. The Low-Flow Pittsburgh Ambulatory Lung (LF-PAL) is a low-flow ECCO2R device that integrates the fiber bundle (0.65 m2) and centrifugal pump into a compact unit to permit patient ambulation.MethodsA blood analog was used to evaluate the performance of the pump at various impeller rotation rates. In vitro CO2 removal tested under normocapnic conditions and 6-h hemolysis testing were completed using bovine blood. Computational fluid dynamics and a mass-transfer model were also used to evaluate the performance of the LF-PAL.ResultsThe integrated pump was able to generate flows up to 700 mL/min against the Hemolung 15.5 Fr dual lumen catheter. The maximum vCO2 of 105 mL/min was achieved at a blood flow rate of 700 mL/min. The therapeutic index of hemolysis was 0.080 g/(100 min). The normalized index of hemolysis was 0.158 g/(100 L).ConclusionsThe LF-PAL met pumping, CO2 removal, and hemolysis design targets and has the potential to enable ambulation while on ECCO2R.

show abstract

“…Vor diesen Hintergründen kann eine breite Anwendung extrakorporaler Verfahren zur CO 2 -Elimination nicht empfohlen werden. Das Therapieverfahren ist aber vielversprechend und sollte primär an erfahrenen Zentren vor allen Dingen im Rahmen wissenschaftlicher Studien zum Einsatz kommen [427,431].…”

Section: Extrakorporale Co 2 -Eliminationunclassified

Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

et al. 2018

View full text Add to dashboard Cite

This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria.

show abstract

Extracorporeal Support for Chronic Obstructive Pulmonary Disease: A Bright Future

Cited by 12 publications

References 65 publications

ECCO2R as a bridge to a decision in type II respiratory failure

ECCO2R as a bridge to a decision in type II respiratory failure

Bench Validation of a Compact Low-Flow CO2 Removal Device

Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

Contact Info

Product

Resources

About