Early Extubation by ECCO2R Compared to IMV in Patients with Severe Acute Exacerbation of COPD

Inclusion Criteria: 1. Informed consent signed and dated by the investigator; and 1. if patient is able to give consent: by the study patient 2. if patients unable to give consent: by the legal representative or 3. if an emergency situation is determined: by an independent consultant physician. 2. Minimum age of 18 years 3. In case of female patients: 1. Postmenopausal status defined as I. Prior bilateral oophorectomy Or II. Age ≥60 years Or if Age is \<60 years or cannot be determined 2. A negative pregnancy test, defined as negative beta hCG test with a hCG level \<5 mIU/mL. 4. Known History of COPD 5. Acute exacerbation of COPD requiring invasive mechanical ventilation 6. Failed extubation attempt or extubation not possible within 24 hours after intubation 7. Acute and potentially reversible cause of respiratory failure as determined by the treating physician Exclusion Criteria: 1. Any conditions which could interfere with the patient's ability to comply with the study 2. In case of female patients: pregnancy and lactation period 3. Participation in any interventional clinical study during the preceding 30 days 4. Platelets \<70.000/µl at baseline 5. Previous participation in the X-COPD study 6. Endotracheally intubated and mechanically ventilated for \>96 hours prior to randomization 7. Acute liver failure, defined by an international normalized ratio (INR) \>2 without anticoagulation and/or bilirubin \>4 mg/dL (\>68 μmol/L) and/or hepatic encephalopathy (all three apply) 8. PaO2/FiO2 ratio \<120 mmHg measured with FiO2 of 1.0 9. Expectation of disease progression leading to high-flow extracorporeal membrane oxygenation (ECMO) treatment 10. Cerebral haemorrhage 11. Tracheostomy 12. Estimated life expectancy \<6 months due to reasons other than COPD 13. Acute ischemic stroke 14. Contraindication to anticoagulation 15. Severe chronic liver disease (Child Pugh C) 16. Acute pulmonary embolism requiring thrombolytic therapy 17. Acute or chronic heart failure with left ventricular ejection fraction \<30% 18. Acute or chronic renal failure requiring dialysis 19. Organ transplantation or immunosuppression due to ongoing immunosuppressive medication or neutropenia for instance following organ transplantation or anticancer therapy 20. Neuromuscular disorder or chronic restrictive lung disease affecting native lung ventilation 21. Known Heparin induced thrombocytopenia type II 22. Acute coronary syndrome and myocardial infarction 23. Obesity hypoventilation syndrome 24. BMI \>40 25. Patient not expected to survive 48 hours 26. Do not resuscitate (DNR) order