Frontiers in Medicine (Nov 2020)

Extracorporeal Carbon Dioxide Removal Using a Renal Replacement Therapy Platform to Enhance Lung-Protective Ventilation in Hypercapnic Patients With Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome

  • Faeq Husain-Syed,
  • Faeq Husain-Syed,
  • Faeq Husain-Syed,
  • Horst-Walter Birk,
  • Jochen Wilhelm,
  • Jochen Wilhelm,
  • Jochen Wilhelm,
  • Jochen Wilhelm,
  • Claudio Ronco,
  • Claudio Ronco,
  • V. Marco Ranieri,
  • Bianka Karle,
  • Stefan Kuhnert,
  • Khodr Tello,
  • Khodr Tello,
  • Khodr Tello,
  • Matthias Hecker,
  • Matthias Hecker,
  • Rory E. Morty,
  • Rory E. Morty,
  • Rory E. Morty,
  • Rory E. Morty,
  • Susanne Herold,
  • Susanne Herold,
  • Susanne Herold,
  • Oliver Kehl,
  • Hans-Dieter Walmrath,
  • Hans-Dieter Walmrath,
  • Werner Seeger,
  • Werner Seeger,
  • Werner Seeger,
  • Werner Seeger,
  • Werner Seeger,
  • Werner Seeger,
  • István Vadász,
  • István Vadász,
  • István Vadász

DOI
https://doi.org/10.3389/fmed.2020.598379
Journal volume & issue
Vol. 7

Abstract

Read online

Coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (ARDS) is associated with high mortality. Lung-protective ventilation is the current standard of care in patients with ARDS, but it might lead to hypercapnia, which is independently associated with worse outcomes. Extracorporeal carbon dioxide removal (ECCO2R) has been proposed as an adjuvant therapy to avoid progression of clinical severity and limit further ventilator-induced lung injury, but its use in COVID-19 has not been described yet. Acute kidney injury requiring renal replacement therapy (RRT) is common among critically ill COVID-19 patients. In centers with available dialysis, low-flow ECCO2R (<500 mL/min) using RRT platforms could be carried out by dialysis specialists and might be an option to efficiently allocate resources during the COVID-19 pandemic for patients with hypercapnia as the main indication. Here, we report the feasibility, safety, and efficacy of ECCO2R using an RRT platform to provide either standalone ECCO2R or ECCO2R combined with RRT in four hypercapnic patients with moderate ARDS. A randomized clinical trial is required to assess the overall benefit and harm.Clinical Trial Registration:ClinicalTrials.gov. Unique identifier: NCT04351906.

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