Bench to Bedside Review: Extracorporeal Carbon Dioxide Removal, Past Present and Future

Overview

Journal Crit Care

Specialty Critical Care

Date 2012 Sep 28

PMID 23014710

Citations 43

Authors

Matthew E Cove

Graeme MacLaren

William J Federspiel

John A Kellum

Affiliations

Soon will be listed here.

Abstract

Acute respiratory distress syndrome (ARDS) has a substantial mortality rate and annually affects more than 140,000 people in the USA alone. Standard management includes lung protective ventilation but this impairs carbon dioxide clearance and may lead to right heart dysfunction or increased intracranial pressure. Extracorporeal carbon dioxide removal has the potential to optimize lung protective ventilation by uncoupling oxygenation and carbon dioxide clearance. The aim of this article is to review the carbon dioxide removal strategies that are likely to be widely available in the near future. Relevant published literature was identified using PubMed and Medline searches. Queries were performed by using the search terms ECCOR, AVCO2R, VVCO2R, respiratory dialysis, and by combining carbon dioxide removal and ARDS. The only search limitation imposed was English language. Additional articles were identified from reference lists in the studies that were reviewed. Several novel strategies to achieve carbon dioxide removal were identified, some of which are already commercially available whereas others are in advanced stages of development.

Citing Articles

Forty years on, why are we still publishing extracorporeal carbon dioxide removal feasibility studies?.

Cove M, Combes A, P Hilty M Crit Care. 2025; 29(1):35.

PMID: 39833959 PMC: 11748350. DOI: 10.1186/s13054-024-05213-6.

Recent Advances and Future Directions in Extracorporeal Carbon Dioxide Removal.

Lamas T, Fernandes S, Vasques F, Karagiannidis C, Camporota L, Barrett N J Clin Med. 2025; 14(1.

PMID: 39797096 PMC: 11722077. DOI: 10.3390/jcm14010012.

Monitoring and modulation of respiratory drive in patients with acute hypoxemic respiratory failure in spontaneous breathing.

Mocellin A, Guidotti F, Rizzato S, Tacconi M, Bruzzi G, Messina J Intern Emerg Med. 2024; 19(8):2105-2119.

PMID: 39207721 PMC: 11582292. DOI: 10.1007/s11739-024-03715-3.

Extracorporeal carbon dioxide removal for patients with acute respiratory failure: a systematic review and meta-analysis.

Zhou Z, Li Z, Liu C, Wang F, Zhang L, Fu P Ann Med. 2023; 55(1):746-759.

PMID: 36856550 PMC: 9980035. DOI: 10.1080/07853890.2023.2172606.

[Recent research on extracorporeal carbon dioxide removal].

Wang X, Guo Y Zhongguo Dang Dai Er Ke Za Zhi. 2023; 25(2):205-209.

PMID: 36854699 PMC: 9979386. DOI: 10.7499/j.issn.1008-8830.2208187.

References

Tao W, Schroeder T, Bidani A, Cardenas Jr V, Nguyen P, Bradford D . Improved gas exchange performance of the intravascular oxygenator by active blood mixing. ASAIO J. 1994; 40(3):M527-32. DOI: 10.1097/00002480-199407000-00056. View

Batchinsky A, Jordan B, Regn D, Necsoiu C, Federspiel W, Morris M . Respiratory dialysis: reduction in dependence on mechanical ventilation by venovenous extracorporeal CO2 removal. Crit Care Med. 2011; 39(6):1382-7. DOI: 10.1097/CCM.0b013e31820eda45. View

Cox Jr C, Zwischenberger J, Kurusz M . Development and current status of a new intracorporeal membrane oxygenator (IVOX). Perfusion. 1991; 6(4):291-6. DOI: 10.1177/026765919100600409. View

Gattinoni L, Carlesso E, Langer T . Clinical review: Extracorporeal membrane oxygenation. Crit Care. 2011; 15(6):243. PMC: 3388693. DOI: 10.1186/cc10490. View

Terragni P, Del Sorbo L, Mascia L, Urbino R, Martin E, Birocco A . Tidal volume lower than 6 ml/kg enhances lung protection: role of extracorporeal carbon dioxide removal. Anesthesiology. 2009; 111(4):826-35. DOI: 10.1097/ALN.0b013e3181b764d2. View

Peek G, Killer H, Reeves R, Sosnowski A, Firmin R . Early experience with a polymethyl pentene oxygenator for adult extracorporeal life support. ASAIO J. 2002; 48(5):480-2. DOI: 10.1097/00002480-200209000-00007. View

Young M, Manning H, Wilson D, Mette S, Riker R, Leiter J . Ventilation of patients with acute lung injury and acute respiratory distress syndrome: has new evidence changed clinical practice?. Crit Care Med. 2004; 32(6):1260-5. DOI: 10.1097/01.ccm.0000127784.54727.56. View

BRAMSON M, OSBORN J, Main F, OBrien M, Wright J, GERBODE F . A NEW DISPOSABLE MEMBRANE OXYGENATOR WITH INTEGRAL HEAT EXCHANGE. J Thorac Cardiovasc Surg. 1965; 50:391-400. View

Federspiel W, Hout M, Hewitt T, LUND L, Heinrich S, Litwak P . Development of a low flow resistance intravenous oxygenator. ASAIO J. 1997; 43(5):M725-30. View

10.

Chang B, GARELLA S . Complete extracorporeal removal of metabolic carbon dioxide by alkali administration and dialysis in apnea. Int J Artif Organs. 1983; 6(6):295-8. View

11.

Russ M, Deja M, Ott S, Bedarf J, Keckel T, Hiebl B . Experimental high-volume hemofiltration with predilutional tris-hydroxymethylaminomethane for correction of low tidal volume ventilation-induced acidosis. Artif Organs. 2011; 35(6):E108-18. DOI: 10.1111/j.1525-1594.2011.01204.x. View

12.

Iglesias M, Martinez E, Badia J, Macchiarini P . Extrapulmonary ventilation for unresponsive severe acute respiratory distress syndrome after pulmonary resection. Ann Thorac Surg. 2007; 85(1):237-44. DOI: 10.1016/j.athoracsur.2007.06.004. View

13.

Gille J, Saunier C, SCHRIJEN F, Hartemann D, Tousseul B . Metabolic CO2 removal by dialysis: THAM vs NaOH infusion. Int J Artif Organs. 1989; 12(11):720-7. View

14.

Kolobow T, Gattinoni L, Tomlinson T, Pierce J . Control of breathing using an extracorporeal membrane lung. Anesthesiology. 1977; 46(2):138-41. DOI: 10.1097/00000542-197702000-00012. View

15.

Kalhan R, Mikkelsen M, Dedhiya P, Christie J, Gaughan C, Lanken P . Underuse of lung protective ventilation: analysis of potential factors to explain physician behavior. Crit Care Med. 2006; 34(2):300-6. DOI: 10.1097/01.ccm.0000198328.83571.4a. View

16.

OCroinin D, Nichol A, Hopkins N, Boylan J, OBrien S, OConnor C . Sustained hypercapnic acidosis during pulmonary infection increases bacterial load and worsens lung injury. Crit Care Med. 2008; 36(7):2128-35. DOI: 10.1097/CCM.0b013e31817d1b59. View

17.

Bein T, Zimmermann M, Hergeth K, Ramming M, Rupprecht L, Schlitt H . Pumpless extracorporeal removal of carbon dioxide combined with ventilation using low tidal volume and high positive end-expiratory pressure in a patient with severe acute respiratory distress syndrome. Anaesthesia. 2009; 64(2):195-8. DOI: 10.1111/j.1365-2044.2008.05735.x. View

18.

Kolobow T, Spragg R, Pierce J, Zapol W . Extended term (to 16 days) partial extracorporeal blood gas exchange with the spiral membrane lung in unanesthetized lambs. Trans Am Soc Artif Intern Organs. 1971; 17:350-4. View

19.

Mihelc K, Frankowski B, Lieber S, Moore N, Hattler B, Federspiel W . Evaluation of a respiratory assist catheter that uses an impeller within a hollow fiber membrane bundle. ASAIO J. 2009; 55(6):569-74. DOI: 10.1097/MAT.0b013e3181bc2655. View

20.

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View