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    Extracorporeal carbon dioxide removal for acute respiratory failure

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    1 Draft recommendations

    1.1 For people with acute hypoxic respiratory failure, extracorporeal carbon dioxide removal should not be used. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.

    1.2 For people with acute hypercapnic respiratory failure, extracorporeal carbon dioxide removal should be used only in research. Find out what only in research means on the NICE interventional procedures guidance page.

    1.3 Patient selection should be done by a multidisciplinary team including clinicians with specialist expertise in managing acute hypercapnic respiratory failure.

    1.4 The procedure should only be done by clinicians with specialist expertise in the procedure in specialist intensive care centres with appropriate levels of support.

    1.5 Research should report:

    • short- and long-term:

      • patient-reported outcomes

      • improvements in respiratory function

    • adverse events including:

      • bleeding

      • symptomatic and asymptomatic intracranial bleeding

      • infection

      • cannulation complications

      • pain.

    Why the committee made these recommendations

    Some people with acute respiratory failure have low levels of oxygen in their blood (acute hypoxic respiratory failure). When compared with standard care, available evidence shows that extracorporeal carbon dioxide removal has no effect on how long these people live, how long they spend in hospital, or how long they spend in intensive care. There is also evidence of an increased risk of bleeding in the brain when this procedure is used. So, this procedure should not be done for acute hypoxic respiratory failure.

    Some people with acute respiratory failure have increased levels of carbon dioxide in their blood (acute hypercapnic respiratory failure). There is limited evidence for the efficacy of extracorporeal carbon dioxide removal in this group, and there are safety concerns around its use. When compared with standard care, the evidence suggests that people who have this procedure spend less time on ventilation, and there is no change in the number of serious adverse events. But it is uncertain if this procedure leads to improved long-term benefits. So, this procedure should only be used in research for acute hypercapnic respiratory failure.