We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
A bi‐centric experience of extracorporeal carbon dioxide removal (ECCO<sub>2</sub>R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation.
- Authors
Wohlfarth, Philipp; Schellongowski, Peter; Staudinger, Thomas; Rabitsch, Werner; Hermann, Alexander; Buchtele, Nina; Turki, Amin T.; Tzalavras, Asterios; Liebregts, Tobias
- Abstract
Acute respiratory failure (ARF) is the main reason for ICU admission following allogeneic hematopoietic stem cell transplantation (HSCT). Extracorporeal CO2 removal (ECCO2R) can be used as an adjunct to mechanical ventilation in patients with severe hypercapnia but has not been assessed in HSCT recipients. Retrospective analysis of all allogeneic HSCT recipients ≥18 years treated with ECCO2R at two HSCT centers. 11 patients (m:f = 4:7, median age: 45 [IQR: 32‐58] years) were analyzed. Acute leukemia was the underlying hematologic malignancy in all patients. The time from HSCT to ICU admission was 37 [8‐79] months, and 9/11 (82%) suffered from chronic graft‐versus‐host disease (GVHD) with lung involvement. Pneumonia was the most frequent reason for ventilatory decompensation (n = 9). ECCO2R was initiated for severe hypercapnia (PaCO2: 96 [84‐115] mm Hg; pH: 7.13 [7.09‐7.27]) despite aggressive mechanical ventilation (invasive, n = 9; non‐invasive, n = 2). ECCO2R effectively resolved blood gas disturbances in all patients, but only 2/11 (18%) could be weaned off ventilatory support, and one (9%) patient survived hospital discharge. Progressive respiratory and multiorgan dysfunction were the main reasons for treatment failure. ECCO2R was technically feasible but resulted in a low survival rate in our cohort. A better understanding of the prognosis of ARF in patients with chronic GVHD and lung involvement is necessary before its use can be reconsidered in this setting.
- Subjects
HEMATOPOIETIC stem cell transplantation; ADULT respiratory distress syndrome; SURVIVAL rate; TREATMENT failure; PROGNOSIS; CARBON dioxide
- Publication
Artificial Organs, 2021, Vol 45, Issue 8, p903
- ISSN
0160-564X
- Publication type
Article
- DOI
10.1111/aor.13931