Diehl J L, Boisramé-Helms J, Chardon-Couteau A, Commereuc M, Augy J-L, Sokoloff A, Rivet N, Gaussem P, Smadja D M, Aissaoui N
Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France; Inserm UMR-S 1140, innovations thérapeutiques en hémostase, faculté de pharmacie de Paris, université Paris Descartes, 75006 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
Rev Mal Respir. 2017 Jun;34(6):598-606. doi: 10.1016/j.rmr.2017.02.003. Epub 2017 May 12.
The aim of extracorporeal removal of CO (ECCOR) is to ensure the removal of CO without any significant effect on oxygenation. ECCOR makes use of low to moderate extracorporeal blood flow rates, whereas extracorporeal membrane oxygenation (ECMO) requires high blood flows.
For each ECCOR device it is important to consider not only performance in terms of CO removal, but also cost and safety, including the incidence of hemolysis and of hemorrhagic and thrombotic complications. In addition, it is possible that the benefits of such techniques may extend beyond simple removal of CO. There have been preliminary reports of benefits in terms of reduced respiratory muscle workload. Mobilization of endothelial progenitor cells could also occur, in analogy to the data reported with ECMO, with a potential benefit in term of pulmonary repair. The most convincing clinical experience has been reported in the context of the acute respiratory distress syndrome (ARDS) and severe acute exacerbations of chronic obstructive pulmonary disease (COPD), especially in patients at high risk of failure of non-invasive ventilation.
Preliminary results prompt the initiation of randomized controlled trials in these two main indications. Finally, the development of these technologies opens new perspectives in terms of long-term ventilatory support.
体外一氧化碳清除（ECCOR）的目的是确保在不对氧合产生任何显著影响的情况下清除一氧化碳。ECCOR采用低至中等的体外血流速率，而体外膜肺氧合（ECMO）则需要高血流量。
对于每种ECCOR设备，不仅要考虑一氧化碳清除方面的性能，还要考虑成本和安全性，包括溶血、出血和血栓形成并发症的发生率。此外，这些技术的益处可能不仅限于简单的一氧化碳清除。有初步报告称，这些技术在减轻呼吸肌工作量方面有益处。类似于ECMO报告的数据，内皮祖细胞的动员也可能发生，这在肺修复方面可能具有潜在益处。最令人信服的临床经验是在急性呼吸窘迫综合征（ARDS）和慢性阻塞性肺疾病（COPD）严重急性加重的背景下报告的，尤其是在无创通气失败风险高的患者中。
初步结果促使在这两个主要适应症中开展随机对照试验。最后，这些技术的发展为长期通气支持开辟了新的前景。
