Extracorporeal carbon dioxide removal (ECCO₂R) is a form of extracorporeal life support (ECLS) largely aimed at removing carbon dioxide in patients with acute hypoxemic or acute hypercapnic respiratory failure, so as to minimize respiratory acidosis, allowing more lung protective ventilatory settings which should decrease ventilator-induced lung injury. ECCO₂R is increasingly being used despite the lack of high-quality evidence, while complications associated with the technique remain an issue of concern. This review explains the physiological basis underlying the use of ECCO₂R, reviews the evidence regarding indications and contraindications, patient management and complications, and addresses organizational and ethical considerations. The indications and the risk-to-benefit ratio of this technique should now be carefully evaluated using structured national or international registries and large randomized trials.

体外二氧化碳清除 (ECCO ₂ R) 是体外生命支持 (ECLS) 的一种形式，主要旨在清除急性低氧血症或急性高碳酸血症呼吸衰竭患者的二氧化碳，以最大限度地减少呼吸性酸中毒，允许更多的肺保护性通气设置，从而应减少呼吸机引起的肺损伤。尽管缺乏高质量证据，但ECCO _{2 R 越来越多地被使用，而与该技术相关的并发症仍然是一个值得关注的问题。这篇综述解释了使用 ECCO 2}的生理基础R，审查有关适应症和禁忌症、患者管理和并发症的证据，并解决组织和伦理方面的考虑。现在应该使用结构化的国家或国际注册和大型随机试验仔细评估该技术的适应症和风险收益比。