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

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

JOURNAL=Frontiers in Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.654658

DOI=10.3389/fmed.2021.654658

ISSN=2296-858X

ABSTRACT=<p><bold>Purpose:</bold> 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 (ECCO<sub>2</sub>R) based on the renal replacement therapy (RRT) platform in these patients was assessed.</p><p><bold>Methods:</bold> 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 PaCO<sub>2</sub> after the application of the ECCO<sub>2</sub>R system. Ventilation parameters [tidal volume (VT), respiratory rate, and PEEP], platform pressure (Pplat) and driving pressure (DP), respiratory system compliance, arterial blood gases, and ECCO<sub>2</sub>R system characteristics were collected.</p><p><bold>Results:</bold> Twelve patients with refractory hypercapnia were enrolled, and the PaCO<sub>2</sub> 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, PaCO<sub>2</sub> 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.</p><p><bold>Conclusions:</bold> A low-flow ECCO<sub>2</sub>R system based on the RRT platform enabled CO<sub>2</sub> 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.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov/" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.clinicaltrials.gov/</ext-link>, identifier NCT04340414.</p>