• Alain Combes, Daniel Brodie, Nadia Aissaoui, Thomas Bein, Gilles Capellier, Heidi J Dalton, Jean-Luc Diehl, Stefan Kluge, Daniel F McAuley, Matthieu Schmidt, Arthur S Slutsky, and Samir Jaber.
• Sorbonne Université INSERM Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France. alain.combes@aphp.fr.
• Intensive Care Med. 2022 Oct 1; 48 (10): 130813211308-1321.

AbstractExtracorporeal 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.© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.

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