1.1 Current evidence on the safety of extracorporeal carbon dioxide removal (ECCO2R) for acute respiratory failure shows several serious but well-recognised complications. Evidence on its efficacy is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
1.2 Clinicians wishing to do ECCO2R should:
Inform the clinical governance leads in their trusts.
Ensure that patients (if possible) and their families or carers understand the uncertainty about the procedure's efficacy and the risk of complications and provide them with clear written information. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having ECCO2R (see section 1.4 and section 7.1).
1.3 Only patients with potentially reversible acute respiratory failure or those being considered for lung transplantation should be selected for this procedure. ECCO2R should only be used by specialist intensive care teams trained in its use.
1.4 NICE encourages clinicians to enter patients into ongoing trials such as the protective ventilation with veno-venous lung assist in respiratory failure (REST) trial, and to collaborate in data collection initiatives such as the Extracorporeal Life Support Organization register. Data collected should include information on patient selection criteria, thresholds for intervention, the type of ECCO2R technique being used and clinical outcomes. NICE may update the guidance on publication of further evidence.