ICU · Respiratory

Extracorporeal CO2 removal (ECCO2R) in ICU

Also known as ECCO2R · Extracorporeal carbon dioxide removal · CO2 removal · Low-flow ECMO · Respiratory dialysis

Extracorporeal CO2 removal (ECCO2R): low-flow extracorporeal circuit that removes CO2 WITHOUT substantially improving oxygenation (unlike VV-ECMO). Indications: (1) HYPERCAPNIC respiratory failure (COPD exacerbation) where NIV is at risk of failing — ECCO2R removes CO2 → may avoid intubation. (2) FACILITATE ultra-protective ventilation in ARDS (remove CO2 while using very low tidal volumes down to ~4 mL/kg → less volutrauma). (3) BRIDGE to lung transplant. ADVANTAGE over VV-ECMO: lower flow (roughly 0.4-1.5 L/min) → smaller cannulae → less invasive. LIMITATION: minimal oxygenation (cannot treat severe hypoxaemia — need VV-ECMO for that). EVIDENCE: feasibility shown in SUPERNOVA and CRRT-platform cohorts, but the REST randomized trial found no 90-day mortality benefit — ECCO2R remains investigational, specialist-centre, carefully selected patients.