Practice and Perceptions on Extracorporeal Carbon Dioxide Removal in the Current Era: A Multinational Survey

Introduction Extracorporeal carbon dioxide removal (ECCO 2 R) is a type of partial extracorporeal respiratory support with potential to reduce lung injury in patients with hypercapnic respiratory failure. We aimed to study the current practice and perceptions of ECCO 2 R and the need for an ECCO 2 R registry. Methods A multinational survey was conducted among clinicians who have published clinical studies on ECCO 2 R or have used ECCO 2 R within the last 5 years in Europe, Asia, Oceania and the United States. Results Seventy responses from 140 requests (response rate: 50%) were received from physicians across all targeted regions. ECCO 2 R is reported to be used mainly for ARDS (46%) management, followed by asthma (18%) and COPD (15%). Eighty‐five percent of the participants reported low case volumes (0–10 cases per year). Variations in the practice of ECCO 2 R were evident, including triggers for initiating ECCO 2 R, devices used, access catheter type and size, targeted blood flow rates and monitoring of anticoagulation. The most common barriers to wider use of ECCO 2 R included lack of evidence, followed by the device's costs and operational complexity. Eighty‐four percent (48/57) of the respondents thought an ECCO 2 R registry would be useful, and 98% (47/48) of the respondents reported that they would be willing to contribute to a dedicated ECCO 2 R registry. Conclusion ECCO 2 R practices varied considerably, but most respondents agreed on the usefulness of a dedicated ECCO 2 R registry. Practice variations may be associated with suboptimal outcomes. ECCO 2 R quality indicators are needed to optimise clinical outcomes and resource utilisation.