Venovenous CO2 Removal (VVCO2R) in Patients With COPD and Acute Respiratory Failure

Inclusion Criteria: 1. Acute respiratory failure on invasive mechanical ventilation or 2. Acute respiratory failure and an advanced directive foregoing invasive mechanical ventilation 3. Established diagnosis of COPD 4. Age group: 18 years or greater Exclusion Criteria: 1. Significant vasopressor support 2. Systolic BP \< 100 torr systolic despite vasopressor support 3. Class III or Class IV congestive heart failure 4. Left ventricular ejection fraction \< 30% by previous echocardiogram 5. Recent (6 month) history of myocardial infarction 6. Coronary artery disease with unstable angina 7. Recent (6 month) history of venous embolism 8. Uncontrolled coagulopathy (international normalized ratio (INR) \> 5 or activated partial thromboplastin time (aPTT) \> 80s) despite corrective therapy 9. History of heparin-induced thrombocytopenia or other adverse event following the administration of heparin (heparin group only) 10. Pregnancy 11. Severe chronic liver disease 12. Severe anemia (Hgb \< 9 gm/dl) 13. Any contraindication to systemic anticoagulation with heparin, including recent central nervous system injury or hemorrhage, retinal hemorrhage or other recent hemorrhage from sites which cannot be controlled 14. Technically unable to access vessels (obesity, limb deformity, previous surgery at the site, infection, etc.) 15. Evidence of increased intracranial pressure or history of an intracranial hemorrhage within the past 3 months