Role of Extracorporeal Carbon Dioxide Removal in Respiratory Failure in Adults: A Case Series and Narrative Review of Literature

Aim and background: This article aims to find out the role of extracorporeal carbon dioxide removal (ECCO2R) as an adjunct to mechanical ventilation in respiratory failure in adults.It also aims to find out the role of ECCO2R in preventing invasive mechanical ventilation in adults with chronic obstructive pulmonary disease (COPD) presenting with respiratory failure.Materials and methods: A case series of three patients who were admitted with respiratory failure in the medical intensive care unit (ICU) of a tertiary care hospital in Eastern India from January 2023 till December 2023 and received ECCO2R therapy were included.A descriptive case summary of these patients has been provided.A narrative literature review has been done using the keywords "extracorporeal carbon dioxide removal, " "adults, " "respiratory failure, " and "chronic obstructive pulmonary disease" in PubMed.A review of the literature has been presented.Results: Among the three patients, two of the patients were admitted with acute exacerbation of COPD and had type II respiratory failure.Both patients had a PaO 2 of less than 50 mm of Hg and a pCO 2 of more than 90 mm of Hg at admission.The third patient had interstitial lung disease and presented with an acute worsening of the same with type II respiratory failure.This patient also had a PaO 2 of 45 mm of Hg and a pCO 2 of 86 mm of Hg at admission.All of them received ECCO2R therapy.One of the patients with COPD required only noninvasive ventilation and subsequently improved.The other patient with COPD required invasive mechanical ventilation but subsequently was weaned off ventilation.The patient with interstitial lung disease was mechanically ventilated but subsequently succumbed to the illness.All the patients received other standard therapy as per protocol.The narrative literature review suggested an evolving, significant role of ECCO2R as an adjunct to mechanical ventilation in promoting lung protective ventilation.Also, evidence suggested the role of ECCO2R in the prevention of invasive mechanical ventilation in type II respiratory failure in adult patients with COPD.Conclusion: Extracorporeal carbon dioxide removal might have a significant role in type II respiratory failure in adults in promoting lung protective ventilation strategy.It might also help to prevent invasive mechanical ventilation in adult patients with COPD presenting with type II respiratory failure.Clinical significance: This finding might help to reduce ventilator-associated lung injury and promote more lung-protective ventilation with a wider use of ECCO2R in type II respiratory failure in adults.Also, it might help to prevent invasive mechanical ventilation and its associated complications in adults with COPD presenting with type II respiratory failure.