ecco2R to facilitatE earLy libEration From mechanicAl Ventilation inpatientS With Copd Acute Exacerbation

Inclusion Criteria: * Inclusion criteria * Age ≥ 18 * Known or suspected aeCOPD that failed NIV that requires invasive mechanical ventilation * Failed treatment with NIV defined as: * NIV for at least 2 hours and no more than 24 hours with signs of respiratory distress (respiratory rate \> 30 breaths/min and use of accessory muscles or paradoxical abdominal movements) AND * PaCO2\> 55 mmHg and pH \< 7.25 or pH \< 7.30 and PaCO2 \> 55 mmHg, with PaCO2 decrease \< 20% from baseline • Known or suspected aeCOPD patients where NIV is contraindicated and need immediate invasive mechanical ventilation due to: * Respiratory arrest * Inability to protect the airway (impaired cough or swallowing or massive aspiration or respiratory pauses with loss of consciousness or gasping of air) * Inability to clear secretions * Agitated and confused patients * Facial deformities or conditions that prevent mask from fitting * Uncooperative or unmotivated patients Exclusion Criteria: * Participation in other interventional studies * Patients already included in this study that need a new readmission because of a new aeCOPD episode * aeCOPD intubated \> 12 hours * Extubation within the previous 48 hours following intubation and invasive mechanical ventilation due to any cause * Anatomical abnormalities or vascular diseases preventing the correct insertion of the ECCO2R cannula * PaO2 to FiO2 ratio \< 150 on PEEP ≥ 5 cmH2O * Known or suspected pregnancy (women of childbearing potential require a pregnancy test) * Hemodynamic instability defined as * MAP \< 60 mmHg despite the infusion of fluids or vasoactive drugs OR * Failure to increase systolic blood pressure above 80-90 mmHg OR * Need for inotropic drugs to maintain systolic blood pressure\> 85 mmHg OR * ECG evidence of ischemia or significant uncontrolled ventricular arrhythmia * Acute multiple organ failure defined as more than two organ failures assessed by SOFA score. Organ dysfunction can be identified as an acute change in total SOFA score \> 2 points * Decompensated heart failure defined as an exacerbation of symptoms or signs after a period of relative stability such as dyspnea, fatigue or edema in the setting of previously established myocardial dysfunction (systolic or diastolic)32 and B-natriuretic peptide more than100 ng/L. * Tracheostomized patients * Untreated pulmonary embolism, pleural effusion, pneumothorax or bronchopleural fistula as the primary cause of acute respiratory failure * Hemoglobin \< 7 gr/dL that require daily transfusion to maintain hemoglobin above 7 gr/dL at the time of screening * Active major bleeding defined as35: * Fatal bleeding * Bleeding that is symptomatic and occurs in a critical area or organ, such as intracranial, intraspinal, intraocular, retroperitoneal, pericardial, in a non-operated joint, or intramuscular with compartment syndrome, assessed in consultation with the MD * Extrasurgical site bleeding causing a fall in hemoglobin level of 2 gr/dL or more or leading to transfusion of two or more units of whole blood or red cells, with temporal association within 24-48 hours to the bleeding * Recent major surgery in the last 2 weeks * Platelet count \< 50 000/mm3 * Prothrombin time-international normalized ratio (INR) \> 1.5 in the absence of anticoagulation therapy * Heparin-induced thrombocytopenia (HIT) or known paradoxical/allergic reactions to heparin * History within the previous 3 months of stroke or severe head trauma or intracranial arterio-venous malformation, or cerebral aneurysm, or central nervous mass lesion or intracranial bleeding * Epidural catheter in place or plan to insert an epidural catheter during the study * Gastrointestinal bleeding within the 6 weeks prior to study entry * Severe liver insufficiency (Child-Pugh scores \>7) or INR \> 1.6 suspected to be related to liver disease (liver associated coagulopathy) * Presence of severe (acute or chronic) renal failure defined as requiring any form of dialysis (including CRRT and CVVH) and/or having a serum creatinine \> 2.5 mg/dL and urine clearance \< 20 mL/hour * Inability to receive blood products * History of complications from extracorporeal support * Permanent home ventilation except for sleep-disordered breathing * Significant weakness or paralysis of respiratory muscles due to causes unrelated to aeCOPD * Recent (\< 7 days) prolonged (\> 24 hours) use of muscle paralyzing agents * Immunocompromised state defined as * Received chemotherapy or radiation within the previous 45 days and still under treatment for the underlying cancer * Received or currently receiving immunosuppressive therapy, excluding corticosteroids, within the last 3 months * Known to have AIDS defined illness * Patients not expected to survive 6 months on the basis of premorbid health status * History of uncontrolled, major psychiatric disorder * Therapeutic restriction (DNR), moribund patient or not expected to survive current hospitalization * Consent declined