ECCO2R in AECOPD
Research type
Research Study
Full title
Extra-corporeal CO2 Removal as an adjunct to Non-Invasive Ventilation in Acute Severe Exacerbations of COPD
IRAS ID
115708
Contact name
Nicholas Barrett
Contact email
Sponsor organisation
Guy's & St Thomas' Foundation NHS Trust
Research summary
Chronic obstructive pulmonary disease (COPD) is one of the UK's commonest chronic diseases, responsible for a significant number of acute hospital admissions (76.9 to 421.6 per 100,000 population). COPD is characterised by progressive lung destruction and respiratory failure. Patients with COPD have recurrent acute exacerbations (AECOPD), where they become more breathless, have increased work of breathing and in severe cases, rising blood carbon dioxide (CO2) levels. The standard management for patients with respiratory failure and high CO2 is non-invasive ventilation (NIV). 70% of patients with NIV improve and have a high likelihood of going home (4% hospital mortality). However approximately 30% of patients with AECOPD will not improve with NIV. These patients require intubation and mechanical ventilation and have an in-hospital mortality rate of 30%.
An alternative to mechanical ventilation is CO2 removal directly from the blood stream, called extra-corporeal CO2 removal (ECCO2R). This uses an approach similar to dialysis where blood is removed from the body, passed through a membrane, has CO2 removed and is then returned to the body. This approach has been the subject of a number of animal experiments demonstrating improved arterial CO2 and pH. Human case series have been published demonstrating the same physiological improvements. In these case series intubation and mechanical ventilation has been avoided. However to date the benefits of this approach have not been tested in a randomised controlled trial. Moreover the impact on work of breathing, patient tolerance and other patient centred-outcomes have not been explored.
ECCO2R offers potential advantages to patients with AECOPD. It should allow improved CO2 clearance and reduced work of breathing that may translate into a reduced likelihood of intubation and mechanical ventilation. This study is designed to explore the physiological and patient-centred outcomes and will form part of the evidence to justify a larger future study.
REC name
East of England - Cambridge Central Research Ethics Committee
REC reference
14/EE/0109
Date of REC Opinion
28 Jul 2014
REC opinion
Further Information Favourable Opinion