title: Extracorporeal CO2 removal in critically ill patients: a systematic review.
abstract: The use of extracorporeal CO2 removal (ECCO2R) is increasingly employed in critically ill patients. However, the clinical evidence supporting its efficacy remains currently poor.
  
  
  
  A systematic review using MEDLINE via PubMed was performed to identify eligible studies (until 30th September 2016). The amount of CO2 reduction, the effect on the duration of mechanical ventilation and weaning, the impact on patients' outcome and the occurrence of complications were evaluated. The quality of evidence was evaluated according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
  
  
  
  Six studies were included (three evaluating patients with chronic obstructive pulmonary disease [COPD]; three evaluating patients with acute respiratory distress syndrome [ARDS]), involving 279 adult patients; 142 treated with ECCO2R and 137 controls. No study on pediatric population met the inclusion criteria for analysis. The overall quality of evidence of the two randomized trials and four case-control studies varied from moderate to very low. PaCO2 was generally reduced by 25-33% within a few hours following ECCO2R initiation. One ARDS study showed a significant decrease in the duration of mechanical ventilation, although this result was only found by post-hoc analysis. The three studies on COPD demonstrated that some patients supported by ECCO2R devices could avoid endotracheal intubation, however the ICU-LOS and survival was not influenced by ECCO2R when compared to controls.
  
  
  
  In COPD patients, a significantly reduced need for endotracheal intubation was reported. However, the use of ECCO2R has not shown significant improvement on the outcome of critically ill patients in the reviewed studies. Therefore appropriately powered, randomized, controlled studies are urgently needed.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Maximilian V
authors.initials: MV
authors.lastname: Malfertheiner
authors.affiliation: Intensive Care Unit and International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Nardo
authors.affiliation: Department of Intensive Care and Emergency Medicine, HELIOS Frankenwaldklinik Kronach, Kronach, Germany.
authors.forename: Justyna
authors.initials: J
authors.lastname: Swol
authors.affiliation: ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars M
authors.initials: LM
authors.lastname: Broman
authors.affiliation: Department of Perfusion, University Hospital Gasthuisberg, Louvain, Belgium.
authors.forename: Leen
authors.initials: L
authors.lastname: Vercaemst
authors.affiliation: Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Barrett
authors.affiliation: Department of Cardiothoracic Anesthesia and Intensive Care, San Raffaele Hospital, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
authors.affiliation: Second Department of Medicine, Cardiovascular Medicine, General University Hospital in Prague, First Faculty of Medicine, Charles University in Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Belohlavek
authors.affiliation: Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.affiliation: Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Hospital, Maastricht, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Second ICU, S.C. Anestesia e Rianimazione 2, IRCCS Policlinico San Matteo Foundation, Pavia, Italy - m.belliato@smatteo.pv.it.
authors.forename: Mirko
authors.initials: M
authors.lastname: Belliato
mesh_terms: D002245:Carbon Dioxide; D016638:Critical Illness; D005112:Extracorporeal Circulation / Q000379:methods*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide