Extracorporeal Carbon Dioxide Removal to Avoid Invasive Ventilation During Exacerbations of Chronic Obstructive Pulmonary Disease: VENT-AVOID Trial – A Randomized Clinical Trial | American Journal of Respiratory and Critical Care Medicine (atsjournals.org)
In a U.S. trial involving 41 institutions and 113 patients with exacerbations of chronic obstructive pulmonary disease (COPD), the impact of extracorporeal CO2 removal (ECCO2R) on reducing ventilation time was assessed. The study, aiming for a sample size of 180, was prematurely halted due to slow enrollment. It explored whether ECCO2R could increase ventilator-free days within the first 5 days post-randomization. Participants were divided into those failing noninvasive ventilation (NIV, n=48) and those difficult to wean from invasive mechanical ventilation (IMV, n=65), receiving either standard care with ECCO2R or standard care alone.
Results revealed no statistically significant difference in median ventilator-free days at 5 days post-randomization between treatment arms across both strata (P=0.36). Specifically, in the NIV group, both ECCO2R and standard care arms reported a median of 5 ventilator-free days. In the IMV group, the median ventilator-free days were slightly higher in the ECCO2R arm (2 days) compared to the standard care arm (0.25 days), yet the difference was not statistically significant.
Furthermore, in-hospital mortality in the NIV stratum was significantly higher in the ECCO2R arm compared to standard care (22% vs. 0%, P=0.02), with no significant mortality difference in the IMV stratum (17% vs. 15%, P=0.73).
This trial indicates that ECCO2R does not significantly improve early liberation from mechanical ventilation in COPD exacerbations and raises concerns about its safety in patients requiring NIV.