ECCO2R in 12 COVID-19 ARDS Patients With Extremely Low Compliance and Refractory Hypercapnia

Xin Ding; Huan Chen; Hua Zhao; Hongmin Zhang; Huaiwu He; Wei Cheng; Chunyao Wang; Wei Jiang; Jie Ma; Yan Qin; Zhengyin Liu; Jinglan Wang; Xiaowei Yan; Taisheng Li; Xiang Zhou; Yun Long; Shuyang Zhang

doi:10.3389/fmed.2021.654658

ECCO₂R in 12 COVID-19 ARDS Patients With Extremely Low Compliance and Refractory Hypercapnia

Front Med (Lausanne). 2021 Jul 8:8:654658. doi: 10.3389/fmed.2021.654658. eCollection 2021.

Authors

Xin Ding¹, Huan Chen¹, Hua Zhao¹, Hongmin Zhang¹, Huaiwu He¹, Wei Cheng¹, Chunyao Wang², Wei Jiang², Jie Ma³, Yan Qin³, Zhengyin Liu⁴, Jinglan Wang⁵, Xiaowei Yan⁶, Taisheng Li⁴, Xiang Zhou¹, Yun Long¹, Shuyang Zhang⁶

Affiliations

¹ Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
² Department of Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³ Department of Nephrology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
⁴ Department of Infectious Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
⁵ Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
⁶ Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Abstract

Purpose: A phenotype of COVID-19 ARDS patients with extremely low compliance and refractory hypercapnia was found in our ICU. In the context of limited number of ECMO machines, feasibility of a low-flow extracorporeal carbon dioxide removal (ECCO₂R) based on the renal replacement therapy (RRT) platform in these patients was assessed. Methods: Single-center, prospective study. Refractory hypercapnia patients with COVID-19-associated ARDS were included and divided into the adjusted group and unadjusted group according to the level of PaCO₂ after the application of the ECCO₂R system. Ventilation parameters [tidal volume (VT), respiratory rate, and PEEP], platform pressure (Pplat) and driving pressure (DP), respiratory system compliance, arterial blood gases, and ECCO₂R system characteristics were collected. Results: Twelve patients with refractory hypercapnia were enrolled, and the PaCO₂ was 64.5 [56-88.75] mmHg. In the adjusted group, VT was significantly reduced from 5.90 ± 0.16 to 5.08 ± 0.43 ml/kg PBW; DP and Pplat were also significantly reduced from 23.5 ± 2.72 mmHg and 29.88 ± 3.04 mmHg to 18.5 ± 2.62 mmHg and 24.75 ± 3.41 mmHg, respectively. In the unadjusted group, PaCO₂ decreased from 94 [86.25, 100.3] mmHg to 80 [67.50, 85.25] mmHg but with no significant difference, and the DP and Pplat were not decreased after weighing the pros and cons. Conclusions: A low-flow ECCO₂R system based on the RRT platform enabled CO₂ removal and could also decrease the DP and Pplat significantly, which provided a new way to treat these COVID-19 ARDS patients with refractory hypercapnia and extremely low compliance. Clinical Trial Registration: https://www.clinicaltrials.gov/, identifier NCT04340414.

Keywords: COVID-19; acute respiratory distress syndrome; driving pressure; extracorporeal carbon dioxide removal; hypercapnia.

Associated data

ClinicalTrials.gov/NCT04340414