Novel ECCO2R Device for Hypercapnic Respiratory Failure

Study Overview
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Brief Summary
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The objective of this study is to assess the efficacy and safety of this new Prismalung+ membrane in its intended clinical setting by demonstrating a reduction in ventilatory parameters and pulmonary energy load or the successful maintenance of spontaneous breathing, respectively, the absence of the need to initiate vv-ECMO therapy, and initial survival.

Detailed Description
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Our hypotheses are that decarboxylation therapy by means of the novel Prismalung+ membrane in patients with hypercapnic respiratory failure (I) allows the reduction of tidal volume, peak airway pressure, dP and pulmonary energy load (as measured by AUC over 72 hours) as compared to baseline in mechanically ventilated patients OR is associated with successful continuation of spontaneous breathing despite respiratory exhaustion (no decision to intubate), and that these patients (II) warrant no decision to initiate vv-ECMO therapy and (III) do not experience early mortality. The primary Objectives of the study are to test our hypotheses I to III by applying the novel Prismalung+ ECCO2R device in mechanically ventilated patients and spontaneously breathing patients experiencing hypercapnic respiratory failure in a multi-central prospective trial in three experienced intensive care units in Switzerland.

Official Title
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A Novel ECCO2R Device as a Lung Protective Measure in Hypercapnic Respiratory Failure: a Prospective Multicenter Trial

Conditions
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Hypercapnic Respiratory Failure

Intervention / Treatment
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* Device: Prismalung + treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mechanically ventilated patient: (I) Progressive respiratory failure (pH≤7.25 and/ or PaCO2 ≥9 kPa) during mechanical ventilation (II) with an inability to maintain lung protective ventilation (VT<4 mL/kg, Ppeak <30 mbar, Driving Pressure ≤12 mbar) OR awake spontaneously breathing patient: Respiratory exhaustion (pH≤7.25 and/or PaCO2 ≥9 kPa) AND Informed Consent as documented by signature Exclusion Criteria: Mechanical Ventilation group: Need for v-v ECMO Awake spontaneously breathing group: Need for mechanical ventilation due to inability to remain un-sedated Thrombocytopenia (<100G/l) Contraindications for Heparin therapy (history of heparin antibodies, previous history of intracranial bleeding) Patients under 18 years of age Women who are pregnant or breast feeding Previous enrolment into the current study Enrolment of the investigator, his/her family members, employees and other dependent persons

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Mechanically ventilated ECCO2R group<br>Adult, mechanically ventilated critically ill patients with respiratory failure and incapacity to sustain lung protective ventilation | Device: Prismalung + treatment<br>* Low-flow extracorporeal CO2 removal with or without concurrent continuous renal replacement therapy<br>|
| Awake spontaneously breathing ECCO2R group<br>Awake, spontaneously breathing critically ill patients suffering from respiratory exhaustion | Device: Prismalung + treatment<br>* Low-flow extracorporeal CO2 removal with or without concurrent continuous renal replacement therapy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tidal volume | Tidal volume (VT [mL/kg]) in mechanically ventilated patients or no intubation in spontaneously breathing patients | At timepoint 1 (72 hours) | 
| Peak Pressure | Peak Pressure (Ppeak [mbar]) in mechanically ventilated patients or no intubation in spontaneously breathing patients | At timepoint 1 (72 hours) | 
| Driving Pressure | Driving Pressure [mbar] in mechanically ventilated patients or no intubation in spontaneously breathing patients | At timepoint 1 (72 hours) | 
| VV-ECMO therapy | No initiation of VV-ECMO therapy | At timepoint 2 (28 days) | 
| Survival | Survival | At timepoint 2 (28 days) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secondary endpoint - respiratory mechanics | Reduction in pulmonary energy load after initiation of ECCO2R as compared to baseline in mechanically ventilated patients | 72 hours | 
| Secondary endpoint - complications | Incidence of complications such as bleeding, thrombosis, coagulatory activation as evidences by thrombocytopenia, elevated D-Dimer levels, and plasmatic coagulatory failure. | 28 days |