Use of ECCO2R with the Hemolung RAS in the Treatment of Severe Hypercapnic Respiratory Failure Caused by SARS-CoV-2 Acute Lung Injury
L. Keith Scott, MD MSc FCCM
Professor of Medicine, Pediatrics and Surgery, Ochsner/LSU Academic Medical Center, Shreveport, Louisiana, USA
This report describes the case of a 57-year-old male with COVID-19 who was transferred to the Ochsner/LSU Academic Medical Center for consideration of treatment with ECMO. The patient was maintaining acceptable levels of oxygenation but was severely hypercapnic with a PaCO2 of 188 mmHg refractory to ventilation adjustments. Instead of ECMO, the patient was treated with extracorporeal CO2 removal (ECCO2R) via percutaneous insertion of a 15.5 French central venous catheter and low blood flows of only 500 mL/min. The patient was anticoagulated with argatroban during therapy to achieve standard anticoagulation levels for extracorporeal life support. The Hemolung device provided rapid and safe reduction in PaCO2 and normalization of pH within a short time and with a comparatively small catheter and performed without complications.
The extracorporeal CO2 removal capabilities of the Hemolung enabled delivery of lung protective ventilation, significant correction of PaCO2 and normalization of pH without the complexities associated with ECMO. No issues were found with the circuit or catheter designed for the Hemolung. Without this additional tool in the arsenal of treatment options for the unpredictable presentation of COVID-19, this patient would likely not have survived.