Extracorporeal carbon dioxide removal for acute respiratory failure

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search incorporating literature published since the last interventional procedures guidance on this procedure and a detailed review of the evidence from 9 sources. This was then discussed by the committee. The evidence included 2 systematic reviews and meta‑analyses, 3 randomised controlled trials (RCTs), a long‑term follow‑up analysis of 1 of the RCTs, 2 case series, and a secondary analysis of 1 of the case series. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: mortality, reduction in hospital length of stay, reduction in intensive care unit length of stay, and reduction in duration of ventilation.

The professional experts and the committee considered the key safety outcomes to be: bleeding, intracranial bleeding, infection, and cannulation complications.

Patient commentary was sought but none was received.

The committee was informed that arteriovenous extracorporeal carbon dioxide removal (ECCO₂R) is largely being replaced by venovenous ECCO₂R in the UK.

The committee noted that there are ongoing clinical trials into ECCO₂R for acute hypercapnic respiratory failure.

The committee was informed that implementation of standard care such as non‑invasive ventilation is variable across centres.