On the horizon: Extracorporeal carbon dioxide removal

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Figure 1
Basic venovenous extracorporeal carbon dioxide removal circuit.

TABLE 1

Differences between extracorporeal carbon dioxide removal (ECCO₂R) and extracorporeal membrane oxygenation (ECMO)

	ECCO₂R			ECMO
	Respiratory dialysis	Membrane lung		Venovenous	Venoarterial
	Respiratory dialysis	Venovenous	Arteriovenous	Venovenous	Venoarterial
Conditions treated	Hypercapnic respiratory failure	Hypercapnic respiratory failure	Hypercapnic respiratory failure	Hypercapnic respiratory failure Hypoxemic respiratory failure	Hypercapnic respiratory failure Hypoxemic respiratory failure Cardiac failure
Circuit	VS → ML → VS VS	→ ML → VS	AS → ML → VS	VS → MO → VS	VS → MO → AS
Flow rates	0.25–0.5 L/min	0.5–5 L/min	0.5–5 L/min	2–6 L/min	2–6 L/min
Pros	Uses current dialysis catheters	Single-catheter options	Pumpless	Oxygenation and CO₂ removal	Oxygenation and CO₂ removal Cardiac support
Cons	CO₂ removal only	CO₂ removal only	CO₂ removal only Mean arterial pressure > 65 mm Hg required	Increased surgical complexity