The Role of the extracorporeal CO2 removal in a patient who had a near-fatal asthma attack

Abstract

[OP-195]The Role of the Extracorporeal CO2 Removal in a Patient Who Had a Near-fatal Asthma AttackMehmet Süleyman Sabaz1, Batuhan Kaya2, Nuray Kamilova2,Ömer Faruk Balcı2, Fethi Gül11Marmara University Faculty of Medicine, Department of Anesthesiology andReanimation, Division of Intensive Care, İstanbul, Turkey2Marmara University Faculty of Medicine, Department of Anesthesiology andReanimation, İstanbul, TurkeyIntroduction: Extracorporeal carbon dioxide removal (ECCO2R) is a respiratory support method that solely offers decarboxylation withminimal blood flow (0.3-1.0 L/min). Here we present the ECCO2R treatment in a patient who was intubated due to hypercarbic respiratory failure afteran asthma attack.Case: A 18-year-old male patient with a diagnosis of asthma admitted to the emergency room with respiratory distress. He was suffering with persistent wheezing and dyspnea. Physical examination showed decreased auscultation in both lungs. Chest X-ray was normal and the blood gas analysis showed a deep respiratory acidosis (Ph: 6.98, pCO2: 162 mmHg, pO2: 208 mmHg, HCO3: -26.4, BE: -1.6). The patient was intubated and admitted to the intensive care unit (ICU). He was treated with budesonide+ salbutamol + ipatropiumbromide + theophylline + intravenous steroid and magnesium sulfate during that period. Neuromuscular blocking agent was added to treatment in addition to deep sedation due to ongoing bronchospasm. Hypercapnia and respiratory acidosis was persist despite high mechanical ventilatory support (PEEP: 10 cmH2O, Psupport: 35 cmH2O, respiratory rate: 30, FiO2:%40). The VV-ECCO2R (multi ECCO2R®- Fresenius Medical Care) was started on the 2nd day of hospitalization.The extracorporeal blood flow was set at 300-350 mL/min, while the sweep gas flow was adjusted to be 3-6 L/min according to the pCO2 value.Unfractionated heparin was used for systemic anticoagulation. In timeshypercarbia regressed gradually, blood gas parameters improved andventilatory supports decreased (Table 1). He was successfully weaned fromthe ECCO2R on the 5th day and then extubated. He was discharged to theward with nasal oxygen support.Discussion: Most asthma attacks can be treated but some patients remainuncontrolled despite adequate therapy. The use of ECCO2R has been shownfor the possibility of earlier extubation after severe asthma attack whoneed invasive-mechanical ventilation. In our patient, who was sufferingfrom life-threathening asthma attack and finally discharged from the ICU,VV-ECCO2R corrected hypercapnia and acidosis, allowed the reduction ofother supportive measures and the favored the weaning from mechanicalventilation.Keywords: ECCO2R, extracorporeal carbon dioxide removal, asthma attack,hypercapnia