We report a case of life-threatening asthma associated with profound hypercapnia and acidosis that was refractory to conventional medical therapy but was managed successfully using an extracorporeal carbon dioxide removal (ECCO2R) device (NovaLung iLA®). In the UK, ECCO2R is still not widely available, with few intensivists and anaesthetists having experience of its use in routine intensive care unit practice. Extracorporeal CO2 removal may have a role in the management of acute life-threatening asthma and in preventing patient death and improving overall outcomes.
KollaSAAwadSSRichPB. Extracorporeal life support for 100 adult patients with severe respiratory failure. Ann Surg1997;226: 544–66.
2.
KukitaIOkamotoKSatoT. Emergency extracorporeal life support for patients with near-fatal status asthmaticus. Am J Emerg Med1997;15: 566–69.
3.
LeibaABar-YusefSBar-DayanY. Early administration of extracorporeal life support for near fatal asthma. Isr Med Assn J2003;5: 600–02.
4.
MacDonnellKMMoonHSSekarTSAhluwaliaMP. Extracorporeal membrane oxygenator support in a case of severe status asthmaticus. Ann Thorac Surg1981;31: 171–75.
5.
SakaiMOtekiHDoiKNaritaY. Clinical use of extracorporeal lung assist for a patient with status asthmaticus?Ann Thorac Surg1996; 62: 885–87.
6.
ShapiroMBKleavelandACBartlettRH. Extracorporeal life support for status asthmaticus. Chest1993;103: 1651–54.
7.
TajimiKKTNakataniTKobayashiK. Extracorporeal lung assist for patients with hypercapnia due to status asthmaticus. Intensive Care Med1988;14: 588–89.
HebbarKPPetrillo-AlbaranoTCoto-PuckettW. Experience with use of extracorporeal life support for severe refractory status astmaticus in children. Crit Care2009;13: R29.
10.
NapolitanoLParkPKRaghavendranKBartlettRH. Nonventilatory strategies for patients with life threatening 2009 H1N1 influenza and severe respiratory failure. Crit Care Med2010;38: e74–e90.
11.
Novalung: Compendium of evidence 5.0. iLA membrane ventilator/Vision alpha HFOV/Mechanical Ventilation. http://www.novalung.com Accessed February 2011.
12.
ElliotSParamasivamKOramJ. Pumpless extracorporeal carbon dioxide removal for life-threatening asthma. Crit Care Med2007;35: 945–48.
13.
ColemanNEDaltonH. Extracorporeal life support for status asthmaticus: the breath of life that's often forgotten. Crit Care2009;13: 136.
14.
LubnowMLuchnerAPhilippA. Combination of high frequency oscillatory ventilation and interventional lung assist in severe acute respiratory distress syndrome. J Crit Care2010;25: 436–44.
