Introduction:Acute respiratory failure(ARF) in COPD patients(pts) is characterized by high levels of hypercapnia. State-of-art treatment includes NIV support.We designed our study from a matched-cohort-study, conducted by Chandra,Del Sorbo et al.in 2014,that provided rationale in use of extracorporeal CO2 removal(ECCO2-r),in hypercapnic ARF & acidosis non responsive to NIV,at risk of endotracheal intubation(ETI).

Aims:The aims of this study are to evaluate effectiveness of NIV and ECCO2-r in hypercapnic ARF with acidosis in COPD pts, and to prevent ETI and all its potential complications (pneumonia,difficultous weaning,tracheostomy,prolonged stay).

Methods:Multicentric Study. Data were collected between 2017 and 2019. We enrolled 14 consecutive pts, 9 men+5 women,admitted in our RICUs, aged between 64±8 y.o; average BMI 31±8,arterial pCO2 was >67±8 mmHg;arterial pH was 7.32±0.15. On admission GCS,SOFA & SAPSII were evaluated. Only pts with mortality risk under 30% and integrity of conciousness were recruited.We focused on 3 primary endpoints: reduction of bloodCO2, increasing of pH and avoid ETI. The secondary endpoints were providing patients early weaning from NIV and reduce lenght-of-stay(LoS). 

Results:11 of 14 pts avoided ETI. 3 were intubated,1 of these died for sepsis. 8 pts were easily weaned from NIV(< 48 hrs),for 3 pts weaning lasts >78±15 hrs. In all 10 pts pH and artCO2 levels returned in normal range after 48h of ECCO2-r. One pt stopped treatment earlier for retroperitoneal bleeding. 11 of 14 pts treated with ECCO2-R avoid ETI. LoS was 9±5 days. For other 2 pts treated with ETI LoS was 21±3 days.

Conlusions:Data support the efficancy of ECCO2-r and NIV,reducing LoS,normalization of pH and pCO2,with fewer complications than ETI, and certainly an easier weaning from NIV.