ECCO2R Therapy

Addressing barriers in caring for your patients

Acute hypercapnia can be a barrier to the use of guideline recommended LPV and NIV strategies:

•      Invasive mechanical ventilation (IMV) with higher plateau pressures, tidal volumes or driving pressures can lead to ventilator-induced lung injury (VILI) and may contribute to multiorgan dysfunction.^{6 - 10}
•      Consequently, clinical guidelines recommend using mechanical ventilation strategies to decrease the risk of lung injury in patients with acute respiratory failure, including lung-protective ventilation (LPV),^{11 - 13} ultra lung-protective ventilation (ULPV),¹⁴ or non-invasive ventilation (NIV).¹⁵

Facilitating use of ventilation strategies for patients with ARDS

•     ECCO₂R therapy can effectively manage hypercapnia to facilitate the use of LPV or ultra lung-protective ventilation (ULPV) in patients with ARDS.^{1 - 4} 
•      ECCO₂R therapy may help manage hypercapnia in patients with ARDS secondary to COVID-19.¹⁶
•     ECCO₂R therapy–enabled LPV and ULPV strategies may provide a cost-effective survival benefit in patients with moderate ARDS.¹⁷

Enabling use of NIV strategies for patients with aeCOPD

•    ECCO₂R therapy, at blood flow ≤ 450 mL/min, may help reduce the need for invasive mechanical ventilation in patients with aeCOPD.²³
•    ECCO₂R therapy can help to prevent intubation and IMV in patients with aeCOPD at risk of NIV failure.^{16, 19 - 21} 
•    Data from a matched cohort study using historic controls indicate that patients with aeCOPD receiving NIV and ECCO₂R therapy had a 73% decreased risk of intubation (HR 0.27; 95% CI 0.07–0.98; P = 0.047) compared with patients receiving NIV alone.¹⁹
   

Integrating with other organ support therapies

•     Patients with acute respiratory failure often experience other forms of organ dysfunction, including renal failure.^{20, 23 - 25} 
•     ECCO₂R therapy can be used at blood flow rates of ≤450 mL/min,²³ enabling integration with other organ support therapies, such as CRRT or blood purification using the same platform.^23,24 
•     Clinicians can provide multiple organ support therapies using a single vascular access, helping to minimize the invasiveness of treatment^20,23,24 and reduce the risk of infection for patients with multiple organ dysfunction.^{26 - 28}

Understanding COVID-19 and ECCO₂R therapy

ECCO₂R therapy can support the use of LPV by managing elevated CO₂ levels:

1. Respiratory cells can become infected with the SARS-CoV-2 virus.²⁹
2. Viral infection and a dysregulated inflammatory immune response can both contribute to lung injury.^30,31
3. Lung injury can present as type L pneumonia, which can progress to severe “ARDS-like” type H, characterized by edema, tissue damage, and severe hypoxemia.^32,33
4. The complications of severe lung injury and its treatment can lead to multiorgan dysfunction, including acute kidney injury.^31,34