Effects of extracorporeal carbon dioxide removal in facilitating ultra-protective ventilation strategies for patients with acute respiratory distress syndrome: a systematic review and meta-analysis

November 12, 2025Frontiers in MedicineOpen Access

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Key Points

Evaluate the efficacy of ECCO2R in enabling ultra-protective ventilation strategies for patients with ARDS.
Systematic search conducted in PubMed, Embase, Web of Science, Cochrane Library until June 2025
Primary outcomes included changes in gas exchange and ventilator settings 24 hours after ECCO2R implementation
Fourteen studies involving 593 ARDS patients included in the analysis.
ECCO2R significantly reduced driving pressure by 3.70 cmH2O (95% CI: -4.05 to -3.34; P<0.001) at 24 hours
Plateau pressure decreased by 3.26 cmH2O (95% CI: -3.70 to -2.82; P<0.001)
28-day mortality rate was 29% (95% CI: 19%-38%) with significant complications including circuit clotting (19%; 95% CI: 13%-26%).

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Systematic review evaluates ECCO2R's role in improving outcomes of ultra-protective ventilation in ARDS, suggesting benefits with caution.

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Zhen et al. (2025) studied this question.

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