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Background  While outcome improvement with extracorporeal CO 2  removal (ECCO 2 R) is not demonstrated, a strong pathophysiological rational supports its use in the setting of acute respiratory distress syndrome (ARDS) and COPD exacerbation. We aimed to describe our single-center experience of ECCO 2 R indications and outcome.    Methods  Patients treated with ECCO 2 R in our medial ICU, from March 2014 to November 2017, were retrospectively enrolled. Primary end point was evolution of ventilator settings during the two first days following ECCO 2 R start.    Results  Thirty-three patients received ECCO 2 R. Seventeen were managed with Hemolung®, 10 with Prismalung®, 4 with ILA®, and 2 with Cardiohelp®. Indications for ECCO 2 R were mild or moderate ARDS ( n  = 16), COPD exacerbation ( n  = 11), or uncontrolled hypercapnia due to other causes ( n  = 6). Four patients were not intubated at the time of ECCO 2 R start. Median duration of ECCO 2 R treatment was 7 days [5–10]. In ARDS patients, between baseline and day 2, median tidal volume and driving pressure decreased from 5.3 [4.4–5.9] mL/kg and 10 [8–15] to 3.8 [3.3–4.1] mL/kg and 9 [8–11], respectively. Prone positioning was performed in 10 of the 16 patients, without serious adverse event. In COPD patients, between baseline and day 2, median ventilation minute and PaCO2 decreased significantly from respectively 7.6 [6.6–8.7] L/min and 9.4 [8.4–10.1] kPa to 5.8 [4.9–6.2] L/min and 6 [5.3–6.8] kPa. Four out of 11 COPD patients were extubated while on ECCO 2 R. Device thrombosis occurred in 5 patients (15%). Hemolysis was documented in 16 patients (48%). One patient died of intracranial hemorrhage, while on ECCO 2 R. Twenty-four patients were discharged from ICU alive. Twenty-eight day mortality was 31% in ARDS, 9% in COPD patients, and 50% in other causes of refractory hypercapnic respiratory failure.    Conclusion  ECCO 2 R was useful to apply ultra-protective ventilation among ARDS patients and improved PaCO 2 , pH, and minute ventilation in COPD patients.    Electronic supplementary material  The online version of this article (10.1186/s40560-018-0304-x) contains supplementary material, which is available to authorized users.

Daily use of extracorporeal CO2 removal in a critical care unit: indications and results