Extracorporeal carbon dioxide removal (ECCO sub(2)R) in patients with acute respiratory failure

Purpose: To review the available knowledge related to the use of ECCO sub(2)R 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: ECCO sub(2)R 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 ECCO sub(2)R in such patient populations remains unclear Conclusions: ECCO sub(2)R is currently an experimental technique rather than an accepted therapeutic strategy in ARF-its safety and efficacy require confirmation in clinical trials.