ECCO2R as an Adjunct to NIV in AECOPD

Inclusion criteria

• Known COPD with an acute exacerbation. An acute exacerbation is defined as per the GOLD criteria as an increase in dyspnoea, cough and/or sputum over the patient's normal symptoms. A severe exacerbation is defined as one requiring hospital admission.
• Patients with a persistent arterial pH<7.30 due primarily to hypercapnic respiratory failure after standard medical therapy and at least 1 hour of NIV.
• Age over 18

Exclusion criteria

• Haemodynamic instability after ensuring euvolaemia
• Acute multiple organ failure requiring other organ supportive therapy, including indication for intubation and mechanical ventilation
• Known allergy/intolerance of heparin including known heparin induced thrombosis and thrombocytopaenia
• Acute uncontrolled haemorrhage
• Intracerebral haemorrhage
• Recent (<6 months) ischaemic cerebrovascular accident
• Organ transplant recipient
• Expected to die within 24 hours
• Venous abnormality or body habitus precluding cannulation
• Contraindication to NIV (as per British Thoracic Society recommendation)

• Facial burns/trauma/recent facial or upper airway surgery
• Vomiting
• Fixed upper airway obstruction
• Undrained pneumothorax
• Recent upper gastrointestinal surgery
• Inability to protect the airway
• Life threatening hypoxaemia (PaO2/FiO2 <20kPa)
• Bowel obstruction
• Patient refusal
• Pregnancy
• Severe hepatic failure (ascites, hepatic encephalopathy or bilirubin >100umol/L)
• Severe chronic cardiac failure (NYHA class III or IV)
• Bleeding diathesis (INR>1.5, platelets <80,000) in the absence of anticoagulation therapy