Extracorporeal CO2removal (ECCO2R) in patients with stable COPD with chronic hypercapnia: A proof-of-concept study

Domiciliary non-invasive ventilation (NIV) effectively reduces arterial carbon dioxide pressure (PaCO2) in patients with stable hypercapnic chronic obstructive pulmonary disease, but a consistent percentage of them may remain hypercapnic. We hypothesised that extracorporeal CO2 removal (ECCO2 R) may lower their PaCO2. Ten patients hypercapnic despite ≥6 months of NIV underwent a 24-hour trial of ECCO2 R. Six patients completed the ECCO2 R-trial with a PaCO2 drop ranging between 23% and 47%. Time to return to baseline after interruption ranged 48-96 hours. In four patients, mechanical events led to ECCO 2 R premature interruption, despite a decreased in PaCO2. This time window free from hypercapnia might allow to propose the concept of CO2 dialysis.