Physiological and Technical Considerations of Extracorporeal CO 2 Removal

Extracorporeal systems are increasingly used in severe hypoxemic and/or hypercapnic respiratory failure [1]. Although recent data have shown an advantage of high-flow veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe acute respiratory distress syndrome (ARDS) [2, 3], there is a paucity of evidence regarding the utility of extracorporeal CO2 removal (ECCO2R, often similarly used: low-flow ECMO) in patients with respiratory failure. Despite this fact, the number of available systems is dramatically increasing. In this chapter, we therefore provide an overview of the currently used technologies with advantages and disadvantages in the light of physiology.