Abstract
Extracorporeal carbon dioxide removal (ECCO2R) is a form of extracorporeal life support (ECLS) largely aimed at removing carbon dioxide in patients with acute hypoxemic or acute hypercapnic respiratory failure, so as to minimize respiratory acidosis, allowing more lung protective ventilatory settings which should decrease ventilator-induced lung injury. ECCO2R is increasingly being used despite the lack of high-quality evidence, while complications associated with the technique remain an issue of concern. This review explains the physiological basis underlying the use of ECCO2R, reviews the evidence regarding indications and contraindications, patient management and complications, and addresses organizational and ethical considerations. The indications and the risk-to-benefit ratio of this technique should now be carefully evaluated using structured national or international registries and large randomized trials.
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AC reports grants and personal fees from MAQUET, Xenios, and Baxter. AC was a past president of EuroELSO and is a member of the executive and scientific committees of ECMONet. DB reports research support from ALung Technologies, and personal fees from Abiomed, Xenios, Medtronic, Inspira and Cellenkos. DB is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet). GC reports personal fees, travel expenses from Baxter and Fresenius. JLD reports research supports, grants and personal fees from ALung Technologies, Xenios, Fresenius Medical Care and Baxter. SK received research support from Cytosorbents and Daiichi Sankyo. He also received lecture fees from Astra, Bard, Baxter, Biotest, Cytosorbents, Daiichi Sankyo, Fresenius Medical Care, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Philips and Zoll. He received consultant fees from Fresenius, Gilead, MSD and Pfizer. DFM reported receiving a grant from the NIHR HTA Programme for the conduct of the REST study. Outside of the submitted work, DFM has received funding to his institution for other studies from the NIHR, Wellcome Trust, Innovate UK, Northern Ireland Health and Social Care Research and Development Office and Randox. DFM has a patent application for an anti-inflammatory treatment issued to his institution. DFM has received fees for consultancy from Bayer, GSK, Boehringer Ingelheim, Eli Lilly and Novartis and SOBI and for being a member of the data monitoring and ethics committee for Vir Biotechnology and Faron studies and as an educational seminar speaker for GSK. MS reports personal fees from Getinge, Xenios, Fresenius Medical Care, Drager, and Baxter. MS is the chair of the scientific committee of EuroELSO. ASS reports personal fees from Xenios and Baxter; he is Chair of the Scientific Committee of the International ECMO Network (ECMONet). SJ reports SJ consulting fees from Drager, Fresenius-Xenios, Baxter, Medtronic, Mindray and Fisher & Paykel. Other authors declare no competing interest.
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Combes, A., Brodie, D., Aissaoui, N. et al. Extracorporeal carbon dioxide removal for acute respiratory failure: a review of potential indications, clinical practice and open research questions. Intensive Care Med 48, 1308–1321 (2022). https://doi.org/10.1007/s00134-022-06796-w
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DOI: https://doi.org/10.1007/s00134-022-06796-w