Extracorporeal carbon dioxide removal for acute respiratory failure: a review of potential indications, clinical practice and open research questions.
Alain CombesDaniel BrodieNadia AissaouiThomas BeinGilles CapellierHeidi J DaltonJean-Luc DiehlStefan KlugeDaniel F McAuleyMatthieu SchmidtArthur S SlutskySamir JaberPublished in: Intensive care medicine (2022)
Extracorporeal carbon dioxide removal (ECCO 2 R) 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. ECCO 2 R 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 ECCO 2 R, 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.
Keyphrases
- respiratory failure
- carbon dioxide
- mechanical ventilation
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- clinical practice
- risk factors
- intensive care unit
- minimally invasive
- case report
- quality improvement
- randomized controlled trial
- decision making
- oxidative stress
- risk assessment
- stress induced
- climate change