Other relevant studies

Other potentially relevant studies to the IP overview that were not included in the main evidence summary (table 2 and table 3) are listed in table 5 below.

Table 5 additional studies identified

Article	Number of people and follow up	Direction of conclusions	Reason study was not included in main evidence summary
Morris AH, Jane Wallace C, Menlove RL et al. (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO₂ removal for adult respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine 149: 295-305.	RCT n=40 Follow up 30 days	No significant difference in survival between MV and ECCO₂R.	Old study, technology has moved on significantly.
Tiruvoipati R, Buscher H, Winearls J et al. (2016) Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure. Critical Care and Resuscitation vol. 18 (no. 4); 261-269	Retrospective review n=15 Follow up to ICU or hospital discharge.	A total of 93% of people survived to weaning from ECCOR, 73% survived to ICU discharge and 67% survived to hospital discharge. Our data shows that ECCOR was safe and effective in this cohort.	Studies with more people or longer follow up are included.
Del Sorbo L, Pisani L, Filippini F et al. (2015) Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Critical care medicine vol. 43 (no. 1); 120-7	Matched cohort study n=25 Follow up to ICU or hospital discharge	Intubation rate in NIV plus ECCO₂R 12% (95% CI, 2.5-31.2) and in NIV only was 33% (95% CI, 14.6-57.0), but the difference was not statistically different (p = 0.1495). Thirteen people (52%) experienced AEs related to extracorporeal CO₂ removal.	Studies with more people or longer follow up are included.
Schellongowski P, Riss K, Staudinger T et al. (2015) Extracorporeal CO₂ removal as bridge to lung transplantation in life-threatening hypercapnia. Transplant international, vol. 28 (no. 3); 297-304	Case series n=20 Follow up 1 year	Hypercapnia and acidosis were effectively corrected in all people within the first 12 h of ILA therapy. Four people were switched to ECMO because of progressive hypoxia or circulatory failure. Nineteen people (95%) were successfully transplanted. Hospital and 1-year survival was 75 and 72%, respectively. Bridging to LTX with ECCO₂-R delivered by av or vv ILA is feasible and associated with high transplantation and survival rates.	Studies with more people or longer follow up are included.
Ethgen O, Goldstein J, Harenski K (2021) A preliminary cost-effectiveness analysis of lung-protective ventilation with extra corporeal carbon dioxide removal (ECCO₂R) in the management of acute respiratory distress syndrome (ARDS). Journal of critical care vol. 63; 45-53	Cost-effectiveness analysis n=3000	ECCO₂R-enabled LPV strategies might provide cost-effective survival benefit. Additional data from interventional and observational studies are needed to support this preliminary model-based analysis.	Cost-effectiveness study, not focused on clinical outcomes.
Consales G, Zamidei L, Turani F (2022) Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study) Blood purification vol. 51 (no. 4); 299-308	Retrospective observational study n=17 Follow up until discharge	12/17 people on MV shifted to protective ventilation, CO₂ clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 people. No treatment-related complications were recorded. ECCO₂R-with renal replacement therapy was effective and safe in people with acute exacerbation of COPD and ARDS associated with acute kidney injury.	Studies with more people or longer follow up are included.
Fanelli V, Ranieri M, Mancebo J (2016) Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Critical care vol. 20; 36	Case series n=15 Follow up 28 days	The low-flow ECCO₂R system safely facilitates a low volume, low pressure ultra-protective MV strategy in people with moderate ARDS.	Studies with more people or longer follow up are included.
Fitzgerald M, Millar J, Blackwood B (2014) Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Critical care vol. 18 (no. 3); 222	Systematic review n=495 Follow up: mortality, ICU and hospital discharge	ECCO₂R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed.	Systematic review but no meta-analysis. Systematic reviews with meta-analysis are included in the main evidence summary.
Aretha D, Fligou F, Kiekkas P (2019) Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS-A Review and Meta-Analysis of the Literature. BioMed research international vol. 2019; 1035730	Systematic review and meta-analysis n=209 Follow up: mortality period not stated	Reports on ECMO and ECCO₂R. Conclusion: According to our results, ECLS use was not associated with a benefit in mortality rate in people with ARDS. However, when restricted to higher-quality studies, ECMO was associated with a significant benefit in mortality rate.	Larger systematic reviews with meta-analysis are included in the main evidence summary. Limited details in ECCO₂R analysis, mainly focused on ECMO.
Moerer O, Harnisch LO, Barwing J (2019) Minimal-flow ECCO₂R in patients needing CRRT does not facilitate lung-protective ventilation. Journal of artificial organs vol. 22 (no. 1); 68-76	Case series n=11 Follow up: ICU discharge	Minimal-flow ECCO₂R in combination with CRRT is sufficient to reduce surrogates for lung-protective MV but was not sufficient to significantly reduce force applied to the lung.	Studies with more people or longer follow up are included.
Wohlfarth P, Schellongowski P, Staudinger T (2021) A bi-centric experience of extracorporeal carbon dioxide removal (ECCO₂ R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation. Artificial organs, vol. 45 (no. 8); 903-910	Case series n=11 Follow up: hospital discharge	ECCO₂R effectively resolved blood gas disturbances in all people, but only 2/11 (18%) could be weaned off ventilatory support, and 1 (9%) person survived hospital discharge. ECCO₂R was technically feasible but resulted in a low survival rate in our cohort.	Studies with more people or longer follow up are included.
Moss CE, Galtrey EJ, Camporota L (2016) A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure. ASAIO journal vol. 62 (no. 4); 458-62	Observational cohort study n=14 Follow up: ICU discharge	Four complications related to ECCO₂R were reported, none resulting in serious adverse outcomes. Ten people were discharged from ICU alive. this technique can be safely used to achieve therapeutic goals in people requiring lung protection, and in COPD.	Studies with more people or longer follow up are included.
Grasselli G, Castagna L, Bottino N et al. (2020) Practical Clinical Application of an Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Distress Syndrome and Acute on Chronic Respiratory Failure. ASAIO journal, vol. 66 (no. 6); 691-697	Case series n=11 Follow up: hospital discharge	A low-flow ECCO₂R device with a large surface membrane lung removes a relevant amount of CO₂ resulting in a decreased arterial PCO₂, an increased arterial pH, and in a reduced ventilatory load.	Studies with more people or longer follow up are included.
Hermann A, Staudinger T, Bojic A et al. (2014) First experience with a new miniaturized pump-driven venovenous extracorporeal CO₂ removal system (iLA Activve): a retrospective data analysis. ASAIO journal vol. 60 (no. 3); 342-7	Case series n=12 Follow up: 30 days	Effective CO₂removal observed in all people, with significant reduction in ventilation pressures and minute volumes at median blood flow rates of 1.2-1.4 litre/minute. Invasiveness of ventilation could be reduced. Additional severe impairment of oxygenation and prolonged MV before ECCO₂-R are factors of adverse prognosis.	Studies with more people or longer follow up are included.
Braune S, Sieweke A, Brettner F (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study. Intensive care medicine vol. 42 (no. 9); 1437-44	Case-control study n=25 Follow up: 90 days	The use of vvECCO₂R to avoid IMV was successful in just over half of the cases. However, relevant ECCO₂R-associated complications occurred in over one-third of cases. Despite the shorter period of IMV in the ECCO₂R group there were no significant differences in length of stay or in 28- and 90-day mortality rates between the 2 groups.	Studies with more people or longer follow up are included.
Hilty M, Riva T, Cottini SR et al. (2017) Low-flow venovenous extracorporeal CO₂ removal for acute hypercapnic respiratory failure. Minerva anestesiologica vol. 83 (no. 8); 812-823	Case series n=20 Follow up: ICU discharge	In mechanically ventilated people with HRF, low-flow ECCO₂R supports the maintenance of lung-protective tidal volume and peak ventilator pressure. In selected awake people with acute HRF, it may be a novel treatment approach to avoid MV.	Studies with more people or longer follow up are included.
Braune S, Burchardi H, Engel M et al. (2015) The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis. BMC Anesthesiology vol. 15; 160	Cost analysis of case-control study n=42 Follow up: hospital discharge	Additional costs for the use of arteriovenous ECCO₂R to avoid IMV in people with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.	Cost analysis study, not clinically focused.
Burki NK, Mani, RK, Herth FJF et al. (2013) A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest vol. 143 (no. 3); 678-686	Case series n=20 Follow up:	This single-catheter, low-flow ECCO₂R system provided clinically useful levels of CO₂ removal in these people with COPD.	Studies with more people or longer follow up are included.
Chiumello D, Pozzi T,Mereto E (2022) Long-term feasibility of ultraprotective lung ventilation with low-flow extracorporeal carbon dioxide removal in ARDS patients. Journal of critical care vol. 71; 154092	Case series n=10 Follow up: 5 days	The application of low-flow ECCO₂R support allowed a reduction of respiration rate. During the following 5 days no changes in mechanics variables and gas exchange occurred.	Studies with more people or longer follow up are included.
Cho WH, Lee K, Huh JW (2012) Physiologic effect and safety of the pumpless extracorporeal interventional lung assist system in patients with acute respiratory failure--a pilot study. Artificial organs vol. 36 (no. 4); 434-8	Case series n=11 Follow up: ICU discharge	iLA showed effective CO(2) removal, allowed for reducing the invasiveness of MV in people with severe respiratory failure from various causes even using a small-sized catheter and was safe in small body-sized people.	Studies with more people or longer follow up are included.
Schmidt M, Jaber S, Zogheib E (2018) Feasibility and safety of low-flow extracorporeal CO₂ removal managed with a renal replacement platform to enhance lung-protective ventilation of patients with mild-to-moderate ARDS. Critical care vol. 22 (no. 1); 122	Case series n=20 Follow up: 28 days	A low-flow ECCO₂R device managed with an RRT platform easily and safely enabled very low tidal volume ventilation with moderate increase in PaCO₂ in people with mild-to-moderate ARDS.	Studies with more people or longer follow up are included.
Seiler F, Trudzinski FC, Hennemann K et al. (2017) The Homburg Lung: Efficacy and Safety of a Minimal-Invasive Pump-Driven Device for Veno-Venous Extracorporeal Carbon Dioxide Removal. ASAIO journal vol. 63 (no. 5); 659-665	Case series n=24 Follow up: hospital discharge	Reduction in CO₂, increase in blood pH. 2 cannulation-associated complications. The Homburg lung provides effective CO₂ removal in hypercapnic lung failure. The cannulation is a safe procedure, with complication rates comparable to those in central venous catheter implantation.	Studies with more people or longer follow up are included.
Munshi L, Telesnicki T, Walkey A et al. (2014) Extracorporeal life support for acute respiratory failure a systematic review and meta-analysis Annals of the American Thoracic Society, vol. 11 (no. 5); 802-810	Systematic review and meta-analysis n=1248 Follow up: Hospital mortality	ECLS was not associated with a mortality benefit in people with acute respiratory failure. However, a significant mortality benefit was seen when restricted to higher-quality studies of venovenous ECLS.	Did not separate out ECCO₂R from ECMO.
Ding X, Chen H, Zhao H et al. (2021) ECCO₂R in 12 COVID-19 ARDS Patients With Extremely Low Compliance and Refractory Hypercapnia Frontiers in medicine, vol. 8; 654658	Case series n=12 Follow up: hospital discharge	A low-flow ECCO₂R system based on the RRT platform enabled CO₂ removal and could also decrease the driving pressure and plateau pressure significantly, which provided a new way to treat these COVID-19 ARDS people with refractory hypercapnia and extremely low compliance.	Studies with more people or longer follow up are included.
Bryner B, Miskulin J, Smith C (2014) Extracorporeal life support for acute respiratory distress syndrome because of severe Legionella pneumonia Perfusion, vol. 29 (no. 1); 39-43	Case series n=12 Follow up: hospital discharge	75% were successfully weaned off ECLS. ECLS for severe ARDS associated with Legionella pneumonia is an effective treatment option when MV fails, especially when introduced early in the course.	Studies with more people or longer follow up are included. Mix of ECMO and ECCO₂R.
Bromberger BJ, Agerstrand C, Abrams D et al. (2020) Extracorporeal Carbon Dioxide Removal in the Treatment of Status Asthmaticus Critical care medicine vol. 48 (no. 12); e1226-e1231	Case series n=26 Follow up: hospital discharge	Survival to hospital discharge was 100%. 15.4% experienced bleeding that needed a transfusion of packed red blood cells. Early extubation in select people receiving ECCO₂R is safe and feasible.	Studies with more people or longer follow up are included.
Zhu Y, Zhen W, Zhang X et al. (2022) Extracorporeal Carbon Dioxide Removal in Patients with Acute Respiratory Distress Syndrome or Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Blood purification 1-11	Systematic review and meta-analysis n=532 Follow up: hospital discharge and 28 day mortality	There was no statistically significant difference in the prognosis of people with and without ECCO₂R treatment. ECCO₂R significantly reduced PaCO₂ and improved PaO₂/FiO₂ and pH values in people with ARDS or COPD. Bleeding was the most common ECCO₂R-related AE.	Larger systematic reviews with meta-analysis are included in the main evidence summary.
Alessandri F, Tonetti T, Pistidda L et al. (2022) Extracorporeal CO₂ Removal During Renal Replacement Therapy to Allow Lung-Protective Ventilation in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome ASAIO	Case series n=27 Follow up: discontinuation of treatment	These data show that in people with COVID-19-induced ARDS and AKI, ECCO₂R-plus-RRT is effective in allowing ultra-protective ventilator settings while maintaining an effective support of renal function and values of pH within physiologic limits.	Studies with more people or longer follow up are included.
Zhang R, Tian C, Cai S et al. (2022) Efficacy and Safety of a Low-Flow Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Failure, a Pilot Study in China Blood purification	Case series n=12 Follow up: ICU discharge	A statistically significant reduction in respiratory rate, driving pressure, PaCO₂, and blood lactate was observed. 50% were discharged alive from ICU. Three complications related to LF-ECCO₂R were reported, none resulting in serious adverse outcomes.	Studies with more people or longer follow up are included.
Augy JL, Aissaoui N, Richard C et al. (2019) A 2-year multicenter, observational, prospective, cohort study on extracorporeal CO₂ removal in a large metropolis area, Journal of Intensive Care vol. 7 (no. 1); 45	Prospective cohort study n=70 Follow up: ICU discharge	Based on a registry, a low rate of ECCO₂R device utilization seen, mainly in severe COPD and ARDS people. Physiological efficacy was confirmed in these 2 populations. Safety concerns such as haemolysis, bleeding, and thrombosis, with different profiles between the devices.	Studies with more people or longer follow up are included.
Worku E, Brodie D, Ling RR et al. (2022) Venovenous extracorporeal CO₂ removal to support ultraprotective ventilation in moderate-severe acute respiratory distress syndrome: A systematic review and meta-analysis of the literature Perfusion.	Systematic review and meta-analysis n=421	Random effects modelling indicated a 3.56 cmH2O reduction (95%-CI: 3.22-3.91) in driving pressure from baseline (p <.001) and a 1.89 ml/kg (95%-CI: 1.75-2.02, p <.001) reduction in tidal volume. Bleeding and haemolysis were the commonest complications of therapy.	Larger systematic reviews with meta-analysis are included in the main evidence summary. This review focuses on ventilator settings and does not focus on mortality.
Nentwich J, Wichmann D, Kluge S et al. (2019) Low-flow CO₂ removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study Annals of intensive care vol. 9 (no. 1); 3	Case series n=20 Follow up: ICU discharge	The investigated low-flow ECCO₂R and renal replacement system can ameliorate respiratory acidosis and decrease ventilation requirements in hypercapnic people with concomitant renal failure.	Studies with more people or longer follow up are included.
Diehl J-L, Piquilloud L, Vimpere D (2020) Physiological effects of adding ECCO₂R to invasive mechanical ventilation for COPD exacerbations Annals of intensive care vol. 10 (no. 1); 126	Case series n=12 Follow up: hospital discharge	Using a formalized protocol of respiratory rate adjustment, ECCO₂R permitted to effectively improve pH and diminish PaCO₂ at the early phase of IMV in 12 AE-COPD people, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in work of breathing was also observed during the weaning process.	Studies with more people or longer follow up are included.
Winiszewski H, Aptel F, Belon F et al. (2018) Daily use of extracorporeal CO₂ removal in a critical care unit: Indications and results. Journal of intensive care vol. 6 (no. 1); 36	Case series n=33 Follow up: 28 day mortality	Twenty-eight day mortality was 31% in ARDS, 9% in COPD, and 50% in other causes of refractory hypercapnic respiratory failure. ECCO₂R was useful to apply ultra-protective ventilation among ARDS people and improved PaCO₂, pH, and minute ventilation in COPD.	Studies with more people or longer follow up are included.
Morelli A, D'Egidio A, Orecchioni A et al. (2015) Extracorporeal CO₂ removal in hypercapnic patients who fail noninvasive ventilation and refuse endotracheal intubation: A case series Intensive Care Medicine Experimental, vol. 3 (no. supplement1); a824	Retrospective cohort study n=30 Follow up: 28 day mortality	Mortality at day 28 was significantly lower in the treated group than in control group (23.3% compared with 58.1%, p< 0.001). In the treated group none of people experienced bleeding events with a heparin infusion in the circuit. Nevertheless 8 people had clots in the circuit which needed the substitution of the circuit.	Studies with more people or longer follow up are included.
Fischer S, Simon AR, Welte T et al. (2006) Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung. The journal of thoracic and cardiovascular surgery vol. 131 (no. 3); 719-23	Case series n=12 Follow up: 1 year	10 out of 12 people were successfully bridged to lung transplantation, and 8 are still alive (1-year survival, 80%). This report suggests that interventional lung assist NovaLung implantation is an effective bridge to lung transplantation strategy in people with ventilation-refractory hypercapnia.	Studies with more people or longer follow up are included.
Bein T, Weber F, Philipp A et al. (2006) A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Critical care medicine, vol. 34 (no. 5); 1372-7	Case series n=90 Follow up: hospital discharge	The incidence of complications was 24.4%, mostly because of ischaemia in a lower limb. Thirty-seven of 90 people survived, creating a lower mortality rate than expected from the Sequential Organ Failure Assessment score.	Studies with more people or longer follow up are included.
Ricci D, Boffini M, Del Sorbo L et al. (2010) The use of CO₂ removal devices in patients awaiting lung transplantation: an initial experience. Transplantation proceedings vol. 42 (no. 4); 1255-8	Case series n=12 Follow up: ICU discharge	Eight people died on the device. Three people were bridged to lung transplantation; 1 recovered and was weaned from the device after 11 days.	Studies with more people or longer follow up are included.
Azzi M, Aboab J, Alviset S et al. (2021) Extracorporeal CO₂ removal in acute exacerbation of COPD unresponsive to non-invasive ventilation. BMJ open respiratory research vol. 8 (no. 1)	Case-control study n=51 Follow up: 90 days	Mean time spent in the ICU and mean hospital stay in the ECCO₂R and control groups were, respectively, 18 compared with 30 days, 29 compared with 49 days, and the 90-day mortality rates were 15% compared with 28%. ECCO₂R was associated with significant improvement of pH and PaCO₂ in people with acute exacerbations of COPD failing NIV therapy.	Studies with more people or longer follow up are included.
Zimmermann M, Bein T, Arlt M et al. (2009) Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study. Critical care, vol. 13 (no. 1); r10	Case series n=51 Follow up: hospital discharge	Initiation of iLA resulted in a marked removal in arterial CO₂ allowing a rapid reduction in tidal volume (less than or equal to 6 ml/kg) and inspiratory plateau pressure. AEs occurred in 6 people (11.9%). The hospital mortality rate was 49%.	Studies with more people or longer follow up are included.
Terragni PP, Del Sorbo L, Mascia L et al. (2009) Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology vol. 111 (no. 4); 826-35	Case series n=32 Follow up: 72 hours	Extracorporeal assist normalised PaCO₂ (50.4 +/- 8.2 mmHg) and pH (7.32 +/- 0.03) and allowed use of VT lower than 6 ml/kg for 144 (84 to 168) h. No patient-related complications were observed.	Studies with more people or longer follow up are included. Mortality not included in outcomes.
Muller T, Lubnow M, Philipp A et al. (2009) Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy. The European respiratory journal vol. 33 (no. 3); 551-8	Case series n=96 Follow up: device removal	Within 2 hours of iLA treatment, arterial oxygen partial pressure/inspired oxygen fraction ratio increased significantly and a fast improvement in arterial CO₂ partial pressure and pH was observed. Interventional lung assist eliminates approximately 50% of calculated total CO₂ production with rapid normalisation of respiratory acidosis.	Studies with more people or longer follow up are included. Mortality not included in outcomes.
Brunet F, Belghith M, Mira JP (1993) Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome. Chest, vol. 104 (no. 3); 889-98	Case series n=23 Follow up: hospital discharge	Increase of PaO₂ obtained rapidly with ECCO₂R-LFPPV, allowing subsequent reduction in inspired oxygen fraction; a reduction of the risk of barotrauma evidenced by a significant decrease in pressures and insufflated volumes; a survival rate of 50 percent. Bleeding was the only complication related to the technique and was the cause of death in 4 people.	Studies with more people or longer follow up are included.
Gattinoni L, Pesenti A, Mascheroni D et al. (1986) Low-frequency positive-pressure ventilation with extracorporeal CO₂ removal in severe acute respiratory failure. JAMA, vol. 256 (no. 7); 881-6	Case series n=43 Follow up: hospital discharge	Lung function improved in 31 people (72.8%), and 21 people (48.8%) eventually survived. Improvement in lung function, when present, always occurred within 48 hours.	Studies with more people or longer follow up are included.
Inal V, Efe S (2021) Extracorporeal carbon dioxide removal (ECCO₂R) therapy in COPD and ARDS patients with severe hypercapnic respiratory failure. A retrospective case-control study Turkish journal of medical sciences	Case-control study n=75 Follow up: 28 days	The survival rate of ECCO₂R people was 68% and significantly higher than 58% survival rate of controls (p= 0.025) In addition, iMV duration (12.8 +/- 2.6 compared with 17.1 +/- 4.9 days, p= 0.007) and length of stay (16.9 +/- 4.1 compared with 18.9 +/- 5.5 days, p= 0.032) were significantly shorter than controls.	Studies with more people or longer follow up are included.

Article

Number of people and follow up

Direction of conclusions

Reason study was not included in main evidence summary

Morris AH, Jane Wallace C, Menlove RL et al. (1994) Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO₂ removal for adult respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine 149: 295-305.

RCT

n=40

Follow up 30 days

No significant difference in survival between MV and ECCO₂R.

Old study, technology has moved on significantly.

Tiruvoipati R, Buscher H, Winearls J et al. (2016) Early experience of a new extracorporeal carbon dioxide removal device for acute hypercapnic respiratory failure.

Critical Care and Resuscitation vol. 18 (no. 4); 261-269

Retrospective review

n=15

Follow up to ICU or hospital discharge.

A total of 93% of people survived to weaning from ECCOR, 73% survived to ICU discharge and 67% survived to hospital discharge. Our data shows that ECCOR was safe and effective in this cohort.

Studies with more people or longer follow up are included.

Del Sorbo L, Pisani L, Filippini F et al. (2015) Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control.

Critical care medicine vol. 43 (no. 1); 120-7

Matched cohort study

n=25

Follow up to ICU or hospital discharge

Intubation rate in NIV plus ECCO₂R 12% (95% CI, 2.5-31.2) and in NIV only was 33% (95% CI, 14.6-57.0), but the difference was not statistically different (p = 0.1495). Thirteen people (52%) experienced AEs related to extracorporeal CO₂ removal.

Studies with more people or longer follow up are included.

Schellongowski P, Riss K, Staudinger T et al. (2015) Extracorporeal CO₂ removal as bridge to lung transplantation in life-threatening hypercapnia.

Transplant international, vol. 28 (no. 3); 297-304

Case series

n=20

Follow up 1 year

Hypercapnia and acidosis were effectively corrected in all people within the first 12 h of ILA therapy. Four people were switched to ECMO because of progressive hypoxia or circulatory failure. Nineteen people (95%) were successfully transplanted. Hospital and 1-year survival was 75 and 72%, respectively. Bridging to LTX with ECCO₂-R delivered by av or vv ILA is feasible and associated with high transplantation and survival rates.

Studies with more people or longer follow up are included.

Ethgen O, Goldstein J, Harenski K (2021) A preliminary cost-effectiveness analysis of lung-protective ventilation with extra corporeal carbon dioxide removal (ECCO₂R) in the management of acute respiratory distress syndrome (ARDS).

Journal of critical care vol. 63; 45-53

Cost-effectiveness analysis

n=3000

ECCO₂R-enabled LPV strategies might provide cost-effective survival benefit. Additional data from interventional and observational studies are needed to support this preliminary model-based analysis.

Cost-effectiveness study, not focused on clinical outcomes.

Consales G, Zamidei L, Turani F (2022) Combined Renal-Pulmonary Extracorporeal Support with Low Blood Flow Techniques: A Retrospective Observational Study (CICERO Study) Blood purification vol. 51 (no. 4); 299-308

Retrospective observational study

n=17

Follow up until discharge

12/17 people on MV shifted to protective ventilation, CO₂ clearance was satisfactorily maintained during the whole observational period, and pH was rapidly corrected. Treatment prevented NIV failure in 4 out of 5 people. No treatment-related complications were recorded. ECCO₂R-with renal replacement therapy was effective and safe in people with acute exacerbation of COPD and ARDS associated with acute kidney injury.

Studies with more people or longer follow up are included.

Fanelli V, Ranieri M, Mancebo J (2016) Feasibility and safety of low-flow extracorporeal carbon dioxide removal to facilitate ultra-protective ventilation in patients with moderate acute respiratory distress syndrome. Critical care vol. 20; 36

Case series

n=15

Follow up 28 days

The low-flow ECCO₂R system safely facilitates a low volume, low pressure ultra-protective MV strategy in people with moderate ARDS.

Studies with more people or longer follow up are included.

Fitzgerald M, Millar J, Blackwood B (2014) Extracorporeal carbon dioxide removal for patients with acute respiratory failure secondary to the acute respiratory distress syndrome: a systematic review. Critical care vol. 18 (no. 3); 222

Systematic review

n=495

Follow up: mortality, ICU and hospital discharge

ECCO₂R is a rapidly evolving technology and is an efficacious treatment to enable protective lung ventilation. Evidence for a positive effect on mortality and other important clinical outcomes is lacking. Rapid technological advances have led to major changes in these devices and together with variation in study design have limited applicability of analysis. Further well-designed adequately powered RCTs are needed.

Systematic review but no meta-analysis.

Systematic reviews with meta-analysis are included in the main evidence summary.

Aretha D, Fligou F, Kiekkas P (2019) Extracorporeal Life Support: The Next Step in Moderate to Severe ARDS-A Review and Meta-Analysis of the Literature. BioMed research international vol. 2019; 1035730

Systematic review and meta-analysis

n=209

Follow up: mortality period not stated

Reports on ECMO and ECCO₂R. Conclusion: According to our results, ECLS use was not associated with a benefit in mortality rate in people with ARDS. However, when restricted to higher-quality studies, ECMO was associated with a significant benefit in mortality rate.

Larger systematic reviews with meta-analysis are included in the main evidence summary.

Limited details in ECCO₂R analysis, mainly focused on ECMO.

Moerer O, Harnisch LO, Barwing J (2019) Minimal-flow ECCO₂R in patients needing CRRT does not facilitate lung-protective ventilation.

Journal of artificial organs vol. 22 (no. 1); 68-76

Case series

n=11

Follow up: ICU discharge

Minimal-flow ECCO₂R in combination with CRRT is sufficient to reduce surrogates for lung-protective MV but was not sufficient to significantly reduce force applied to the lung.

Studies with more people or longer follow up are included.

Wohlfarth P, Schellongowski P, Staudinger T (2021) A bi-centric experience of extracorporeal carbon dioxide removal (ECCO₂ R) for acute hypercapnic respiratory failure following allogeneic hematopoietic stem cell transplantation.

Artificial organs, vol. 45 (no. 8); 903-910

Case series

n=11

Follow up: hospital discharge

ECCO₂R effectively resolved blood gas disturbances in all people, but only 2/11 (18%) could be weaned off ventilatory support, and 1 (9%) person survived hospital discharge. ECCO₂R was technically feasible but resulted in a low survival rate in our cohort.

Studies with more people or longer follow up are included.

Moss CE, Galtrey EJ, Camporota L (2016) A Retrospective Observational Case Series of Low-Flow Venovenous Extracorporeal Carbon Dioxide Removal Use in Patients with Respiratory Failure.

ASAIO journal vol. 62 (no. 4); 458-62

Observational cohort study

n=14

Follow up: ICU discharge

Four complications related to ECCO₂R were reported, none resulting in serious adverse outcomes. Ten people were discharged from ICU alive. this technique can be safely used to achieve therapeutic goals in people requiring lung protection, and in COPD.

Studies with more people or longer follow up are included.

Grasselli G, Castagna L, Bottino N et al. (2020) Practical Clinical Application of an Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Distress Syndrome and Acute on Chronic Respiratory Failure.

ASAIO journal, vol. 66 (no. 6); 691-697

Case series

n=11

Follow up: hospital discharge

A low-flow ECCO₂R device with a large surface membrane lung removes a relevant amount of CO₂ resulting in a decreased arterial PCO₂, an increased arterial pH, and in a reduced ventilatory load.

Studies with more people or longer follow up are included.

Hermann A, Staudinger T, Bojic A et al. (2014) First experience with a new miniaturized pump-driven venovenous extracorporeal CO₂ removal system (iLA Activve): a retrospective data analysis.

ASAIO journal vol. 60 (no. 3); 342-7

Case series

n=12

Follow up: 30 days

Effective CO₂removal observed in all people, with significant reduction in ventilation pressures and minute volumes at median blood flow rates of 1.2-1.4 litre/minute. Invasiveness of ventilation could be reduced. Additional severe impairment of oxygenation and prolonged MV before ECCO₂-R are factors of adverse prognosis.

Studies with more people or longer follow up are included.

Braune S, Sieweke A, Brettner F (2016) The feasibility and safety of extracorporeal carbon dioxide removal to avoid intubation in patients with COPD unresponsive to noninvasive ventilation for acute hypercapnic respiratory failure (ECLAIR study): multicentre case-control study.

Intensive care medicine vol. 42 (no. 9); 1437-44

Case-control study

n=25

Follow up: 90 days

The use of vvECCO₂R to avoid IMV was successful in just over half of the cases. However, relevant ECCO₂R-associated complications occurred in over one-third of cases. Despite the shorter period of IMV in the ECCO₂R group there were no significant differences in length of stay or in 28- and 90-day mortality rates between the 2 groups.

Studies with more people or longer follow up are included.

Hilty M, Riva T, Cottini SR et al. (2017) Low-flow venovenous extracorporeal CO₂ removal for acute hypercapnic respiratory failure.

Minerva anestesiologica vol. 83 (no. 8); 812-823

Case series

n=20

Follow up: ICU discharge

In mechanically ventilated people with HRF, low-flow ECCO₂R supports the maintenance of lung-protective tidal volume and peak ventilator pressure. In selected awake people with acute HRF, it may be a novel treatment approach to avoid MV.

Studies with more people or longer follow up are included.

Braune S, Burchardi H, Engel M et al. (2015) The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation--a cost analysis.

BMC Anesthesiology vol. 15; 160

Cost analysis of case-control study

n=42

Follow up: hospital discharge

Additional costs for the use of arteriovenous ECCO₂R to avoid IMV in people with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.

Cost analysis study, not clinically focused.

Burki NK, Mani, RK, Herth FJF et al. (2013) A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest vol. 143 (no. 3); 678-686

Case series

n=20

Follow up:

This single-catheter, low-flow ECCO₂R system provided clinically useful levels of CO₂ removal in these people with COPD.

Studies with more people or longer follow up are included.

Chiumello D, Pozzi T,Mereto E (2022) Long-term feasibility of ultraprotective lung ventilation with low-flow extracorporeal carbon dioxide removal in ARDS patients. Journal of critical care vol. 71; 154092

Case series

n=10

Follow up: 5 days

The application of low-flow ECCO₂R support allowed a reduction of respiration rate. During the following 5 days no changes in mechanics variables and gas exchange occurred.

Studies with more people or longer follow up are included.

Cho WH, Lee K, Huh JW (2012) Physiologic effect and safety of the pumpless extracorporeal interventional lung assist system in patients with acute respiratory failure--a pilot study.

Artificial organs vol. 36 (no. 4); 434-8

Case series

n=11

Follow up: ICU discharge

iLA showed effective CO(2) removal, allowed for reducing the invasiveness of MV in people with severe respiratory failure from various causes even using a small-sized catheter and was safe in small body-sized people.

Studies with more people or longer follow up are included.

Schmidt M, Jaber S, Zogheib E (2018) Feasibility and safety of low-flow extracorporeal CO₂ removal managed with a renal replacement platform to enhance lung-protective ventilation of patients with mild-to-moderate ARDS.

Critical care vol. 22 (no. 1); 122

Case series

n=20

Follow up: 28 days

A low-flow ECCO₂R device managed with an RRT platform easily and safely enabled very low tidal volume ventilation with moderate increase in PaCO₂ in people with mild-to-moderate ARDS.

Studies with more people or longer follow up are included.

Seiler F, Trudzinski FC, Hennemann K et al. (2017) The Homburg Lung: Efficacy and Safety of a Minimal-Invasive Pump-Driven Device for Veno-Venous Extracorporeal Carbon Dioxide Removal.

ASAIO journal vol. 63 (no. 5); 659-665

Case series

n=24

Follow up: hospital discharge

Reduction in CO₂, increase in blood pH. 2 cannulation-associated complications. The Homburg lung provides effective CO₂ removal in hypercapnic lung failure. The cannulation is a safe procedure, with complication rates comparable to those in central venous catheter implantation.

Studies with more people or longer follow up are included.

Munshi L, Telesnicki T, Walkey A et al. (2014) Extracorporeal life support for acute respiratory failure a systematic review and meta-analysis

Annals of the American Thoracic Society, vol. 11 (no. 5); 802-810

Systematic review and meta-analysis

n=1248

Follow up: Hospital mortality

ECLS was not associated with a mortality benefit in people with acute respiratory failure. However, a significant mortality benefit was seen when restricted to higher-quality studies of venovenous ECLS.

Did not separate out ECCO₂R from ECMO.

Ding X, Chen H, Zhao H et al. (2021) ECCO₂R in 12 COVID-19 ARDS Patients With Extremely Low Compliance and Refractory Hypercapnia

Frontiers in medicine, vol. 8; 654658

Case series

n=12

Follow up: hospital discharge

A low-flow ECCO₂R system based on the RRT platform enabled CO₂ removal and could also decrease the driving pressure and plateau pressure significantly, which provided a new way to treat these COVID-19 ARDS people with refractory hypercapnia and extremely low compliance.

Studies with more people or longer follow up are included.

Bryner B, Miskulin J, Smith C (2014) Extracorporeal life support for acute respiratory distress syndrome because of severe Legionella pneumonia

Perfusion, vol. 29 (no. 1); 39-43

Case series

n=12

Follow up: hospital discharge

75% were successfully weaned off ECLS. ECLS for severe ARDS associated with Legionella pneumonia is an effective treatment option when MV fails, especially when introduced early in the course.

Studies with more people or longer follow up are included.

Mix of ECMO and ECCO₂R.

Bromberger BJ, Agerstrand C, Abrams D et al. (2020) Extracorporeal Carbon Dioxide Removal in the Treatment of Status Asthmaticus

Critical care medicine vol. 48 (no. 12); e1226-e1231

Case series

n=26

Follow up: hospital discharge

Survival to hospital discharge was 100%. 15.4% experienced bleeding that needed a transfusion of packed red blood cells. Early extubation in select people receiving ECCO₂R is safe and feasible.

Studies with more people or longer follow up are included.

Zhu Y, Zhen W, Zhang X et al. (2022) Extracorporeal Carbon Dioxide Removal in Patients with Acute Respiratory Distress Syndrome or Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Blood purification 1-11

Systematic review and meta-analysis

n=532

Follow up: hospital discharge and 28 day mortality

There was no statistically significant difference in the prognosis of people with and without ECCO₂R treatment. ECCO₂R significantly reduced PaCO₂ and improved PaO₂/FiO₂ and pH values in people with ARDS or COPD. Bleeding was the most common ECCO₂R-related AE.

Larger systematic reviews with meta-analysis are included in the main evidence summary.

Alessandri F, Tonetti T, Pistidda L et al. (2022) Extracorporeal CO₂ Removal During Renal Replacement Therapy to Allow Lung-Protective Ventilation in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome

ASAIO

Case series

n=27

Follow up: discontinuation of treatment

These data show that in people with COVID-19-induced ARDS and AKI, ECCO₂R-plus-RRT is effective in allowing ultra-protective ventilator settings while maintaining an effective support of renal function and values of pH within physiologic limits.

Studies with more people or longer follow up are included.

Zhang R, Tian C, Cai S et al. (2022) Efficacy and Safety of a Low-Flow Extracorporeal Carbon Dioxide Removal System in Acute Respiratory Failure, a Pilot Study in China

Blood purification

Case series

n=12

Follow up: ICU discharge

A statistically significant reduction in respiratory rate, driving pressure, PaCO₂, and blood lactate was observed. 50% were discharged alive from ICU. Three complications related to LF-ECCO₂R were reported, none resulting in serious adverse outcomes.

Studies with more people or longer follow up are included.

Augy JL, Aissaoui N, Richard C et al. (2019) A 2-year multicenter, observational, prospective, cohort study on extracorporeal CO₂ removal in a large metropolis area,

Journal of Intensive Care vol. 7 (no. 1); 45

Prospective cohort study

n=70

Follow up: ICU discharge

Based on a registry, a low rate of ECCO₂R device utilization seen, mainly in severe COPD and ARDS people. Physiological efficacy was confirmed in these 2 populations. Safety concerns such as haemolysis, bleeding, and thrombosis, with different profiles between the devices.

Studies with more people or longer follow up are included.

Worku E, Brodie D, Ling RR et al. (2022) Venovenous extracorporeal CO₂ removal to support ultraprotective ventilation in moderate-severe acute respiratory distress syndrome: A systematic review and meta-analysis of the literature

Perfusion.

Systematic review and meta-analysis

n=421

Random effects modelling indicated a 3.56 cmH2O reduction (95%-CI: 3.22-3.91) in driving pressure from baseline (p <.001) and a 1.89 ml/kg (95%-CI: 1.75-2.02, p <.001) reduction in tidal volume. Bleeding and haemolysis were the commonest complications of therapy.

Larger systematic reviews with meta-analysis are included in the main evidence summary.

This review focuses on ventilator settings and does not focus on mortality.

Nentwich J, Wichmann D, Kluge S et al. (2019) Low-flow CO₂ removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study

Annals of intensive care vol. 9 (no. 1); 3

Case series

n=20

Follow up: ICU discharge

The investigated low-flow ECCO₂R and renal replacement system can ameliorate respiratory acidosis and decrease ventilation requirements in hypercapnic people with concomitant renal failure.

Studies with more people or longer follow up are included.

Diehl J-L, Piquilloud L, Vimpere D (2020) Physiological effects of adding ECCO₂R to invasive mechanical ventilation for COPD exacerbations

Annals of intensive care vol. 10 (no. 1); 126

Case series

n=12

Follow up: hospital discharge

Using a formalized protocol of respiratory rate adjustment, ECCO₂R permitted to effectively improve pH and diminish PaCO₂ at the early phase of IMV in 12 AE-COPD people, but not to diminish dynamic hyperinflation in the whole group. A trend toward a decrease in work of breathing was also observed during the weaning process.

Studies with more people or longer follow up are included.

Winiszewski H, Aptel F, Belon F et al. (2018) Daily use of extracorporeal CO₂ removal in a critical care unit: Indications and results.

Journal of intensive care vol. 6 (no. 1); 36

Case series

n=33

Follow up: 28 day mortality

Twenty-eight day mortality was 31% in ARDS, 9% in COPD, and 50% in other causes of refractory hypercapnic respiratory failure. ECCO₂R was useful to apply ultra-protective ventilation among ARDS people and improved PaCO₂, pH, and minute ventilation in COPD.

Studies with more people or longer follow up are included.

Morelli A, D'Egidio A, Orecchioni A et al. (2015) Extracorporeal CO₂ removal in hypercapnic patients who fail noninvasive ventilation and refuse endotracheal intubation: A case series

Intensive Care Medicine Experimental, vol. 3 (no. supplement1); a824

Retrospective cohort study

n=30

Follow up: 28 day mortality

Mortality at day 28 was significantly lower in the treated group than in control group (23.3% compared with 58.1%, p< 0.001). In the treated group none of people experienced bleeding events with a heparin infusion in the circuit. Nevertheless 8 people had clots in the circuit which needed the substitution of the circuit.

Studies with more people or longer follow up are included.

Fischer S, Simon AR, Welte T et al. (2006) Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung.

The journal of thoracic and cardiovascular surgery vol. 131 (no. 3); 719-23

Case series

n=12

Follow up: 1 year

10 out of 12 people were successfully bridged to lung transplantation, and 8 are still alive (1-year survival, 80%). This report suggests that interventional lung assist NovaLung implantation is an effective bridge to lung transplantation strategy in people with ventilation-refractory hypercapnia.

Studies with more people or longer follow up are included.

Bein T, Weber F, Philipp A et al. (2006) A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia.

Critical care medicine, vol. 34 (no. 5); 1372-7

Case series

n=90

Follow up: hospital discharge

The incidence of complications was 24.4%, mostly because of ischaemia in a lower limb. Thirty-seven of 90 people survived, creating a lower mortality rate than expected from the Sequential Organ Failure Assessment score.

Studies with more people or longer follow up are included.

Ricci D, Boffini M, Del Sorbo L et al. (2010) The use of CO₂ removal devices in patients awaiting lung transplantation: an initial experience.

Transplantation proceedings vol. 42 (no. 4); 1255-8

Case series

n=12

Follow up: ICU discharge

Eight people died on the device. Three people were bridged to lung transplantation; 1 recovered and was weaned from the device after 11 days.

Studies with more people or longer follow up are included.

Azzi M, Aboab J, Alviset S et al. (2021) Extracorporeal CO₂ removal in acute exacerbation of COPD unresponsive to non-invasive ventilation.

BMJ open respiratory research vol. 8 (no. 1)

Case-control study

n=51

Follow up: 90 days

Mean time spent in the ICU and mean hospital stay in the ECCO₂R and control groups were, respectively, 18 compared with 30 days, 29 compared with 49 days, and the 90-day mortality rates were 15% compared with 28%. ECCO₂R was associated with significant improvement of pH and PaCO₂ in people with acute exacerbations of COPD failing NIV therapy.

Studies with more people or longer follow up are included.

Zimmermann M, Bein T, Arlt M et al. (2009) Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study.

Critical care, vol. 13 (no. 1); r10

Case series

n=51

Follow up: hospital discharge

Initiation of iLA resulted in a marked removal in arterial CO₂ allowing a rapid reduction in tidal volume (less than or equal to 6 ml/kg) and inspiratory plateau pressure. AEs occurred in 6 people (11.9%). The hospital mortality rate was 49%.

Studies with more people or longer follow up are included.

Terragni PP, Del Sorbo L, Mascia L et al. (2009) Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal.

Anesthesiology vol. 111 (no. 4); 826-35

Case series

n=32

Follow up: 72 hours

Extracorporeal assist normalised PaCO₂ (50.4 +/- 8.2 mmHg) and pH (7.32 +/- 0.03) and allowed use of VT lower than 6 ml/kg for 144 (84 to 168) h. No patient-related complications were observed.

Studies with more people or longer follow up are included.

Mortality not included in outcomes.

Muller T, Lubnow M, Philipp A et al. (2009) Extracorporeal pumpless interventional lung assist in clinical practice: determinants of efficacy.

The European respiratory journal vol. 33 (no. 3); 551-8

Case series

n=96

Follow up: device removal

Within 2 hours of iLA treatment, arterial oxygen partial pressure/inspired oxygen fraction ratio increased significantly and a fast improvement in arterial CO₂ partial pressure and pH was observed. Interventional lung assist eliminates approximately 50% of calculated total CO₂ production with rapid normalisation of respiratory acidosis.

Studies with more people or longer follow up are included.

Mortality not included in outcomes.

Brunet F, Belghith M, Mira JP (1993) Extracorporeal carbon dioxide removal and low-frequency positive-pressure ventilation. Improvement in arterial oxygenation with reduction of risk of pulmonary barotrauma in patients with adult respiratory distress syndrome.

Chest, vol. 104 (no. 3); 889-98

Case series

n=23

Follow up: hospital discharge

Increase of PaO₂ obtained rapidly with ECCO₂R-LFPPV, allowing subsequent reduction in inspired oxygen fraction; a reduction of the risk of barotrauma evidenced by a significant decrease in pressures and insufflated volumes; a survival rate of 50 percent. Bleeding was the only complication related to the technique and was the cause of death in 4 people.

Studies with more people or longer follow up are included.

Gattinoni L, Pesenti A, Mascheroni D et al. (1986) Low-frequency positive-pressure ventilation with extracorporeal CO₂ removal in severe acute respiratory failure.

JAMA, vol. 256 (no. 7); 881-6

Case series

n=43

Follow up: hospital discharge

Lung function improved in 31 people (72.8%), and 21 people (48.8%) eventually survived. Improvement in lung function, when present, always occurred within 48 hours.

Studies with more people or longer follow up are included.

Inal V, Efe S (2021) Extracorporeal carbon dioxide removal (ECCO₂R) therapy in COPD and ARDS patients with severe hypercapnic respiratory failure. A retrospective case-control study

Turkish journal of medical sciences

Case-control study

n=75

Follow up: 28 days

The survival rate of ECCO₂R people was 68% and significantly higher than 58% survival rate of controls (p= 0.025) In addition, iMV duration (12.8 +/- 2.6 compared with 17.1 +/- 4.9 days, p= 0.007) and length of stay (16.9 +/- 4.1 compared with 18.9 +/- 5.5 days, p= 0.032) were significantly shorter than controls.

Studies with more people or longer follow up are included.

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Interventional procedure overview of extracorporeal carbon dioxide removal for acute respiratory failure

Other relevant studies

Table 5 additional studies identified