Low blood flow extracorporeal carbon dioxide removal (ECCO2R): a review of the concept and a case report.

Despite advances in respiratory and critical care medicine, the mortality from ARDS remains unchanged. Recent research suggests current ventilatory therapy may produce additional lung injury, retarding the recovery process of the lung. Alternative supportive therapies, such as ECMO and ECCO2R, ultimately may result in less ventilator induced lung injury. Due to the invasiveness of ECMO/ECCO2R, these modalities are initiated reluctantly and commonly not until patients suffer from terminal or near-terminal respiratory failure. Low flow ECCO2R may offer advantages of less invasiveness and be suitable for early institution before ARDS becomes irreversible. We describe a patient with ARDS and severe macroscopic barotrauma supported with low flow ECCO2R resulting in significant CO2 clearance, reduction of peak, mean airway pressures and minute ventilation.