Extracorporeal carbon dioxide removal (ECCO2R) in patients with acute respiratory failure

Purpose: To review the available knowledge related to the use of ECCO2R as adjuvant strategy to mechanical ventilation (MV) in various clinical settings of acute respiratory failure (ARF). Methods: Expert opinion and review of the literature. Results: ECCO2R may be a promising adjuvant therapeutic strategy for the management of patients with severe exacerbations of COPD and for the achievement of protective or ultra-protective ventilation in patients with ARDS without life-threatening hypoxemia. Given the observational nature of most of the available clinical data and differences in technical features and performances of current devices, the balance of risks and benefits for or against ECCO2R in such patient populations remains unclear Conclusions: ECCO2R is currently an experimental technique rather than an accepted therapeutic strategy in ARF—its safety and efficacy require confirmation in clinical trials.