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Extracorporeal CO2 removal effective in status asthmaticus

Critical Care Medicine
Reuters Health - 22/10/2020 - Venovenous extracorporeal carbon dioxide removal (ECCO2R) may be lifesaving in patients with status asthmaticus refractory to maximal medical therapy, according to a retrospective review.

In a paper in Critical Care Medicine, Dr. Bianca J. Bromberger of Columbia University Irving Medical Center, in New York City, and colleagues note that ECCO2R provides effective gas exchange with minimal to no reliance on the ventilator.

This they say can be advantageous because, although mechanical ventilation may be necessary to support the patient, the cardiopulmonary effects of elevated intrathoracic pressure as well as complications due to positive-pressure ventilation may lead to cardiovascular collapse.

In particular, the researchers point out "Although patients admitted to the hospital for an asthma exacerbation have an overall risk of in hospital death of 0.5%, those requiring invasive mechanical ventilation may have an inhospital mortality of nearly 7%."

To examine the efficacy of ECCO2R in this context the researchers surveyed the records of 26 patients aged 18 years or more who were treated with ECCO2R for status asthmaticus at their institution between 2010 and 2019.

Before ECCO2R cannulation, all patients were mechanically ventilated and receiving albuterol nebulizers and IV steroids. All but one was receiving neuromuscular blockade.

The median duration of ECCO2R support was three days and the total time receiving mechanical ventilation was four days. Twenty patients (76%) were extubated while receiving ECCO2R and none required reintubation.

In the six patients who remained mechanically ventilated the median ECCO2R duration was eight days and the median total duration of mechanical ventilation was 18 days.

By 24 hours after the initiation of ECCO2R, blood gas values were significantly improved. This was also true of peak airway pressures, intrinsic positive end-expiratory pressure, and use of vasopressors. Survival to hospital discharge was 100%.

The most common complication was cannula-associated deep venous thrombosis which was seen in six patients. Four patients experienced bleeding that required a transfusion of packed RBCs.

"Patients with status asthmaticus complicated by refractory hypercapnia, barotrauma, or hemodynamic compromise can be successfully managed with (venovenous) ECCO2R," the researchers conclude, with "very high survival rates with acceptably low rates of complications."

Dr. Bromberger did not respond to requests for comments.

By Reuters Staff

SOURCE: https://bit.ly/34iSY1I Critical Care Medicine, online October 7, 2020.

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