ECCO2R as an Adjunct to NIV in AECOPD

Exclusion Criteria

• •Haemodynamic instability after ensuring euvolaemia
• •Acute multiple organ failure requiring other organ supportive therapy, including indication for intubation and mechanical ventilation
• •Known allergy/intolerance of heparin including known heparin induced thrombosis and thrombocytopaenia
• •Acute uncontrolled haemorrhage
• •Intracerebral haemorrhage
• •Recent (\<6 months) ischaemic cerebrovascular accident
• •Organ transplant recipient
• •Expected to die within 24 hours
• •Venous abnormality or body habitus precluding cannulation
• •Contraindication to NIV (as per British Thoracic Society recommendation)
• •* Facial burns/trauma/recent facial or upper airway surgery
• •* Vomiting
• •* Fixed upper airway obstruction
• •* Undrained pneumothorax
• •* Recent upper gastrointestinal surgery
• •* Inability to protect the airway
• •* Life threatening hypoxaemia (PaO2/FiO2 \<20kPa)
• •* Bowel obstruction
• •* Patient refusal
• •Pregnancy
• •Severe hepatic failure (ascites, hepatic encephalopathy or bilirubin \>100umol/L)
• •Severe chronic cardiac failure (NYHA class III or IV)
• •Bleeding diathesis (INR\>1.5, platelets \<80,000) in the absence of anticoagulation therapy