Background and rationale
Aims and objectives
Methods
Ethics approval
ECCO2R with PrimaLung +
Patient management on ECCO2R
Indications for the use of ECCO2R
Contraindications to ECCO2R
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Contraindication for limited anticoagulation (Heparinisation to achieve an APTT of 50–70 s or an activated clotting time (ACT) of 150–180 s).
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Platelet count of less than 75,000/mm3.
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Patients who had established treatment limitations (i.e., not for cardiopulmonary resuscitation, or admitted to ICU for palliative care or organ donation purposes, not for intubation, mechanical ventilation, and not for continuous renal replacement therapy in ICU).
Primary outcome measure
Secondary outcome measures
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Complications associated with ECCO2R
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Survival to weaning from ECCO2R, ICU and hospital discharge.
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Bleeding: Clinically significant bleeding that required blood transfusions, the need to stop anticoagulation, the need for surgery or any other interventions to stop bleeding during the ECCO2R
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Bleeding from the catheter site
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Intracranial bleeding
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Disseminated intravascular coagulation or thromboembolism
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Pneumothorax
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Cardiac arrhythmias
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Hypothermia
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Haemodynamic instability: Tachycardia or hypotension (< 90 mmHg of systolic blood pressure) at the commencement of ECCO2R that may be attributed to ECCO2R initiation.
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Catheter infection: Infection at catheter site that resulted in bacteraemia.
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Clinically significant haemolysis: Jaundice or anaemia that is not due to another recognisable cause.
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Severe thrombocytopenia (< 50,000/mm3).
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Circuit thrombosis: Clotting of membrane lung or the circuit that needed circuit replacement prior to reaching the expected circuit life (within 72 h of starting the circuit).
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Pump malfunction, inability to start ECCO2R or air in circuit.
Statistical analysis
Results
Variable (n = 10 patients) | |
---|---|
Age in years (median; IQR) | 55.5 (41–68) |
Male, n (%) | 8 (80%) |
ARDS, n (%) | 6 (60%) |
COPD, n (%) | 2 (20%) |
Asthma, n (%) | 2 (20%) |
Serum Bilirubin (umol/L) (median; IQR) | 11 (6–16) |
Serum Albumin (g/L) (median; IQR) | 30 (26–35) |
Urea (mmol/L) (median; IQR) | 15 (11–21) |
Creatinine (umol/L) (median; IQR) | 75 (64–118) |
Hb (median; IQR) | 11 (10–12) |
Platelets (median; IQR) | 234 (159–331) |
WCC (median; IQR) | 15 (11–21) |
APACHE III score (median; IQR) | 47(41–56) |
Vascular access—femoral vein, n (%) | 9 (90%) |
Vascular access—femoral vein, n (%) | 1 (10%) |
Days on IMV prior to ECCO2R (median; IQR) | 0.5 (0–1) |
Days of IMV post ECCO2R (median; IQR) | 4 (1–12) |
Total duration of Mechanical ventilation (days) (median; IQR) | 13.5 (6–26) |
Total Duration of ECCO2R (hours) (median; IQR) | 71 (57–219) |
Total Duration of ICU stay (days) (median; IQR) | 14.5 (8–30) |
Number of ECCO2R kits used per patient (median; IQR) | 1.5 (1–2) |
Prone Position ventilation, n (%) | 1 (10%) |
Inhaled Nitric oxide, n (%) | 1 (10%) |
Survival to ECCO2R weaning, n (%) | 9 (90) |
Survival to ICU discharge, n (%) | 8 (80) |
Survival to hospital discharge, n (%) | 7 (70) |
Patient | Age | Sex | Diagnosis | Duration of ECCO2R (h) | Complications during ECCO2R | Survival to removal of ECCO2R | Survival to ICU discharge | Survival to hospital discharge | Cause of death |
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1 | 68 | Male | ARDS | 261 | Circuit thrombosis < 72 h | Survived | Died | Died | Sepsis secondary to VAP |
2 | 41 | Male | ARDS | 71 | Circuit thrombosis < 72 h | Survived | Survived | Survived | – |
3 | 37 | Female | ASTHMA | 69 | Circuit thrombosis < 72 h | Survived | Survived | Survived | – |
4 | 72 | Male | ARDS | 57 | – | Survived | Survived | Died | Aspiration pneumonitis |
5 | 43 | Male | ARDS | 31.5 | Circuit thrombosis < 72 h | Survived | Survived | Survived | – |
6 | 33 | Male | ARDS | 29 | – | Survived | Survived | Survived | – |
7 | 54 | Female | COPD | 219 | – | Survived | Survived | Survived | – |
8 | 57 | Male | ASTHMA | 71 | – | Survived | Survived | Survived | – |
9 | 78 | Male | ARDS | 275 | – | Died | Died | Died | COVID-19 pneumonia |
10 | 58 | Male | COPD | 89 | – | Survived | Survived | Survived | – |
Variable | Estimated change from before initiation | Standard error | P value |
---|---|---|---|
Minute ventilation | |||
At Initiation | 0.870 | 0.503 | 0.090 |
1–2 h | 0.790 | 0.503 | 0.123 |
6–8 h | 0.720 | 0.503 | 0.159 |
Day 1 | 1.508 | 0.540 | 0.008 |
Day 2 | 0.464 | 0.595 | 0.439 |
Day 3 | 0.486 | 0.778 | 0.535 |
At Removal | 1.447 | 0.519 | 0.008 |
24 h post removal | − 0.629 | 0.564 | 0.271 |
Peak inspiratory pressure (PIP) | |||
At Initiation | 1.000 | 2.947 | 0.736 |
1–2 h | 0.000 | 2.947 | 1.000 |
6–8 h | 2.200 | 2.947 | 0.459 |
Day 1 | 5.599 | 3.160 | 0.083 |
Day 2 | 9.879 | 3.483 | 0.007 |
Day 3 | 6.007 | 4.541 | 0.193 |
At Removal | 5.593 | 3.042 | 0.073 |
24 h post removal | 9.288 | 3.479 | 0.011 |
PaCO2 | |||
At Initiation | 23.430 | 6.110 | 0.0004 |
1–2 h | 29.580 | 6.110 | < 0.0001 |
6–8 h | 30.580 | 6.110 | < 0.0001 |
Day 1 | 38.759 | 6.243 | < 0.0001 |
Day 2 | 36.636 | 6.455 | < 0.0001 |
Day 3 | 37.263 | 7.233 | < 0.0001 |
At Removal | 37.580 | 6.110 | < 0.0001 |
24 h post removal | 38.263 | 6.239 | < 0.0001 |
PaO2 | |||
At Initiation | 3.033 | 10.188 | 0.767 |
1–2 h | 14.756 | 10.188 | 0.155 |
6–8 h | 17.956 | 10.188 | 0.085 |
Day 1 | 20.634 | 10.568 | 0.057 |
Day 2 | 1.628 | 10.838 | 0.881 |
Day 3 | 13.479 | 12.551 | 0.289 |
At Removal | 18.211 | 10.188 | 0.081 |
24 h post removal | 9.008 | 10.557 | 0.398 |
pH | |||
At Initiation | − 0.107 | 0.037 | 0.006 |
1–2 h | − 0.148 | 0.037 | 0.0002 |
6–8 h | − 0.166 | 0.037 | < 0.0001 |
Day 1 | − 0.237 | 0.039 | < 0.0001 |
Day 2 | − 0.211 | 0.041 | < 0.0001 |
Day 3 | − 0.204 | 0.048 | 0.0001 |
At Removal | − 0.244 | 0.037 | < 0.0001 |
24 h post removal | − 0.271 | 0.039 | < 0.0001 |
Respiratory rate | |||
At Initiation | 0.999 | 1.056 | 0.348 |
1–2 h | 0.599 | 1.056 | 0.573 |
6–8 h | 0.399 | 1.056 | 0.707 |
Day 1 | 3.314 | 1.152 | 0.006 |
Day 2 | − 0.172 | 1.293 | 0.894 |
Day 3 | 0.578 | 1.746 | 0.742 |
At Removal | − 0.30 | 1.056 | 0.778 |
24 h post removal | − 0.873 | 1.150 | 0.452 |
Tidal volume | |||
1–2 h | − 18.40 | 32.237 | 0.572 |
6–8 h | − 12.90 | 32.237 | 0.691 |
Day 1 | − 69.591 | 35.078 | 0.055 |
Day 2 | − 42.275 | 39.304 | 0.289 |
Day 3 | − 62.782 | 52.829 | 0.242 |
At Removal | − 8.767 | 33.507 | 0.795 |
24 h post removal | − 47.836 | 36.90 | 0.203 |