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

Extracorporeal carbon dioxide removal (ECCO₂R) 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 ECCO₂R and the need for an ECCO₂R registry.

A multinational survey was conducted among clinicians who have published clinical studies on ECCO₂R or have used ECCO₂R within the last 5 years in Europe, Asia, Oceania and the United States.

Seventy responses from 140 requests (response rate: 50%) were received from physicians across all targeted regions. ECCO₂R 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 ECCO₂R were evident, including triggers for initiating ECCO₂R, devices used, access catheter type and size, targeted blood flow rates and monitoring of anticoagulation. The most common barriers to wider use of ECCO₂R included lack of evidence, followed by the device's costs and operational complexity. Eighty-four percent (48/57) of the respondents thought an ECCO₂R registry would be useful, and 98% (47/48) of the respondents reported that they would be willing to contribute to a dedicated ECCO₂R registry.

ECCO₂R practices varied considerably, but most respondents agreed on the usefulness of a dedicated ECCO₂R registry. Practice variations may be associated with suboptimal outcomes. ECCO₂R quality indicators are needed to optimise clinical outcomes and resource utilisation.