Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS
Background: Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023110863 |
| _version_ | 1797336872405434368 |
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| author | Armand Mekontso Dessap François Bagate Xavier Repesse Clarisse Blayau Muriel Fartoukh Florence Canoui-Poitrine Nicolas de Prost Antoine Vieillard-Baron |
| author_facet | Armand Mekontso Dessap François Bagate Xavier Repesse Clarisse Blayau Muriel Fartoukh Florence Canoui-Poitrine Nicolas de Prost Antoine Vieillard-Baron |
| author_sort | Armand Mekontso Dessap |
| collection | DOAJ |
| description | Background: Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia. Methods: We planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h. Results: Only eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases. Conclusions: This pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials. Trial registration: Registered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807. |
| first_indexed | 2024-03-08T09:01:13Z |
| format | Article |
| id | doaj.art-13d56d3a832341a3bd01f6d0ab9a4532 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T09:01:13Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-13d56d3a832341a3bd01f6d0ab9a45322024-02-01T06:33:57ZengElsevierHeliyon2405-84402024-01-01101e23878Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDSArmand Mekontso Dessap0François Bagate1Xavier Repesse2Clarisse Blayau3Muriel Fartoukh4Florence Canoui-Poitrine5Nicolas de Prost6Antoine Vieillard-Baron7AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France; Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France; Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, France; Corresponding author. AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France.AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France; Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France; Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, FranceAP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, FranceAP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, FranceAP-HP, Hôpital Tenon, Service de Médecine Intensive Réanimation, Paris, FranceAP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Santé Publique, F-94010, Créteil, FranceAP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, F-94010, Créteil, France; Univ Paris Est Créteil, CARMAS, Créteil, F-94010, France; Univ Paris Est Créteil, INSERM, IMRB, Créteil, F-94010, FranceAP-HP, Hôpital Ambroise Paré, Service de Médecine Intensive Réanimation, Boulogne Billancourt, Créteil, FranceBackground: Hypercapnia worsens lung vascular dysfunction during acute respiratory distress syndrome (ARDS). We tested whether an extracorporeal carbon dioxide removal (ECCO2R) device based on a renal replacement therapy platform (Prismalung®) may reduce PaCO2 and alleviate lung vascular dysfunction in ARDS patients with refractory hypercapnia. Methods: We planned to prospectively include 20 patients with moderate-to-severe ARDS, pulmonary vascular dysfunction on echocardiography, and PaCO2 ≥ 48 mmHg despite instrumental dead space reduction and the increase in respiratory rate. Hemodynamics, echocardiography, respiratory mechanics, and arterial blood gases were recorded at 2 (H2), 6 (H6) and 24 (H24) hours as ECCO2R treatment was continued for at least 24 h. Results: Only eight patients were included, and the study was stopped due to worldwide shortage of ECCO2R membranes and the pandemic. Only one patient fulfilled the primary endpoint criterion (decrease in PaCO2 of more than 20 %) at H2, but this objective was achieved in half of patients (n = 4) at H6. The percentage of patients with a PaCO2 value < 48 mmHg increased with time, from 0/8 (0 %) at H0, to 3/8 (37.5 %) at H2 and 4/8 (50 %) at H6 (p = 0.04). There was no major change in hemodynamic and echocardiographic variables with ECCO2R, except for a significant decrease in heart rate. ECCO2R was prematurely discontinued before H24 in five (62.5 %) patients, due to membrane clotting in all cases. Conclusions: This pilot study testing showed a narrow efficacy and high rate of membrane thrombosis with the first version of the system. Improved versions should be tested in future trials. Trial registration: Registered at clinicaltrials.gov, identifier: NCT03303807, Registered: October 6, 2017, https://clinicaltrials.gov/ct2/show/NCT03303807.http://www.sciencedirect.com/science/article/pii/S2405844023110863Extracorporeal removalRenal replacementCarbon dioxide tensionPulmonary vascular dysfunctionAcute respiratory distress syndrome |
| spellingShingle | Armand Mekontso Dessap François Bagate Xavier Repesse Clarisse Blayau Muriel Fartoukh Florence Canoui-Poitrine Nicolas de Prost Antoine Vieillard-Baron Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS Heliyon Extracorporeal removal Renal replacement Carbon dioxide tension Pulmonary vascular dysfunction Acute respiratory distress syndrome |
| title | Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS |
| title_full | Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS |
| title_fullStr | Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS |
| title_full_unstemmed | Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS |
| title_short | Low-flow ECCO2R conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ARDS |
| title_sort | low flow ecco2r conjoined with renal replacement therapy platform to manage pulmonary vascular dysfunction with refractory hypercapnia in ards |
| topic | Extracorporeal removal Renal replacement Carbon dioxide tension Pulmonary vascular dysfunction Acute respiratory distress syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023110863 |
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