Expert perspectives on ECCOR for acute hypoxemic respiratory failure: consensus of a 2022 European roundtable meeting.

Background: By controlling hypercapnia, respiratory acidosis, and associated consequences, extracorporeal CO removal (ECCOR) has the potential to facilitate ultra-protective lung ventilation (UPLV) strategies and to decrease injury from mechanical ventilation. We convened a meeting of European intensivists and nephrologists and used a modified Delphi process to provide updated insights into the role of ECCOR in acute respiratory distress syndrome (ARDS) and to identify recommendations for a future randomized controlled trial.

Results: The group agreed that lung protective ventilation and UPLV should have distinct definitions, with UPLV primarily defined by a tidal volume (V) of 4-6 mL/kg predicted body weight with a driving pressure (ΔP) ≤ 14-15 cmHO.