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 r…