Patients admitted to Emergency or Pulmonology Department, with history of COPD (pulmonary function test available, any Global Obstructive Lung Disease -GOLD- stage), treated with NIV for acute hypercapnic respiratory failure due to AECOPD defined by:
pH \<7.35 + PaCO2 \>45 mmHg (acute hypercapnic respiratory failure) or pH \<7.35 + PaCO2 \> 20% of baseline value (acute on chronic hypercapnic respiratory failure)
Acute worsening of respiratory symptoms that results in additional therapy
Respiratory failure not fully explainable with cardiac failure and at high risk for NIV failure, defined by:
No improvement or worsening of respiratory acidosis (pH \<7.35 and PaCO2 \>45 mmHg) after 2 hours of NIV + one of the following: RR ≥30 bpm; use of accessory respiratory muscle or paradoxical breathing (Combination criteria for NIV failure) or
Glasgow Coma Scale ≤ 11 after 2 hours of NIV (Single criteria for NIV failure) or
Inability to fit mask (facial deformity/intervention/burns) or marked intolerance to interface because of patient's agitation (Single Criteria for NIV failure)
You may not be if
Age \>80 years old
Contraindications to anticoagulation (any of the following: platelet count \<30.000/mm3; activated partial thromboplastin time (aPTT) \>1,5; stroke or severe head trauma or intracranial arteriovenous malformation or cerebral aneurysm in the previous 3 months; central nervous system mass lesion; history of congenital bleeding diatheses; gastro-intestinal bleeding in the previous 6 weeks; gastro-esophageal varices)
Cirrhosis
PaO2/FiO2 ≤ 150 mmHg
Hemodynamic instability (80-90 mmHg increase or 30-40 mmHg decrease systolic arterial pressure compared to baseline value or need of vasopressors to maintain systolic blood pressure higher than 85 mmHg or electrocardiogram evidence of ischemia/arrhythmias)
Body Mass Index ≥37
Impending respiratory arrest
Catheter access to femoral vein or jugular vein impossible
Patient moribund, decision to limit therapeutic interventions
Opposition to participate obtained from the patient or their legally acceptable representative
