Case Report: Extracorporeal Carbon Dioxide Removal in a Severely Brain-Injured Patient With Acute Respiratory Distress Syndrome.

The management of acute respiratory distress syndrome (ARDS) in a patient suffering from a severe brain injury may be difficult, especially when hypercapnia occurs. The rise of PaCO2 may compromise cerebral hemodynamics and increase intracerebral pressure (ICP). We describe herein a case of a 41-year-old man with a severe subarachnoid haemorrhage who develops a severe ARDS consequent to an inhalation pneumonia. Despite optimisation of mechanical ventilation, respiratory mechanics worsened and led to a major hypercapnic acidosis associated with an ICP rise. Because of concomitant ICP elevation and hemodynamic instability, prone positioning was considered too high-risk. We therefore opted for an extracorporeal carbon dioxide removal (ECCO2R) technique first. PaCO2 rapidly decreased, as well as ICP, and the patient could finally be proned while in ECCO2R. ECCO2R was kept for a total of 77 h with no complications. Thereafter, the patient progressively improved and could be weaned from the ventilator after 27 days. He was evaluated 3 months later during an outpatient visit. He was doing well with no sequelae and has resumed previous activities. While the use of extracorporeal decarboxylation techniques is being studied in ARDS, specific investigation in severely brain-injured patients deserves to be conducted.