Initiation of Extracorporeal Carbon Dioxide Removal in Respiratory Failure

Indications for ECCO2R Initiation

ECCO2R should be initiated in patients with acute respiratory failure when conventional ventilation strategies fail to maintain acceptable gas exchange, specifically when there is persistent hypercapnia with respiratory acidosis (pH < 7.25) despite optimized ventilatory support, as recommended by the American Thoracic Society 1, 2
ECCO2R should be considered when patients on invasive mechanical ventilation fail weaning attempts due to hypercapnia, or when ultra-protective ventilation is needed but results in unacceptable hypercapnia, according to the American College of Chest Physicians 1

ECCO2R should be performed at centers with experience in extracorporeal support techniques, with a multidisciplinary team including intensivists, pulmonologists, and respiratory therapists involved in decision-making, as suggested by the American Thoracic Society and the Society of Critical Care Medicine 2, 3

Continuous monitoring of arterial blood pressure and respiratory parameters, regular arterial blood gas analysis, daily echocardiography, meticulous tracking of fluid balance, and monitoring for complications are recommended by the American Association for Respiratory Care 2