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In acute respiratory distress syndrome (ARDS), ECCO<jats:sub>2<\/jats:sub>R has been used to reduce tidal volume, plateau pressure, and driving pressure (\u201cultraprotective ventilation\u201d). Despite achieving these goals, no benefits in outcome could be shown. Thus, in ARDS, the use of ECCO<jats:sub>2<\/jats:sub>R to achieve ultraprotective ventilation can no longer be recommended. Furthermore, ECCO<jats:sub>2<\/jats:sub>R has also been used to avoid intubation or facilitate weaning in obstructive lung failure as well as to avoid mechanical ventilation in patients during bridging to lung transplantation. Although these goals can be achieved in many patients, the effects on outcome still remain unclear due to lack of evidence. Despite involving less blood flow, smaller cannulas, and smaller gas exchange membranes compared with extracorporeal membrane oxygenation, ECCO<jats:sub>2<\/jats:sub>R bears a\u00a0comparable risk of complications, especially bleeding. Trials to define indications and analyze the risk\u2013benefit balance are needed prior to implementation of ECCO<jats:sub>2<\/jats:sub>R as a\u00a0standard therapy. Consequently, until then, ECCO<jats:sub>2<\/jats:sub>R should be used in clinical studies and experienced centers only. This article is freely available.<\/jats:p>","DOI":"10.1007\/s00063-024-01197-x","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T21:01:37Z","timestamp":1728507697000},"page":"59-64","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Is there still a\u00a0place for ECCO2R?","Gibt es noch einen Platz f\u00fcr ECCO2R?"],"prefix":"10.1007","volume":"119","author":[{"given":"Thomas","family":"Staudinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,9]]},"reference":[{"key":"1197_CR1","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1513\/AnnalsATS.201301-021OC","volume":"10","author":"DC Abrams","year":"2013","unstructured":"Abrams\u00a0DC, Brenner\u00a0K, Burkart\u00a0KM et\u00a0al (2013) Pilot study of extracorporeal carbon dioxide removal to facilitate extubation and ambulation in exacerbations of chronic obstructive pulmonary disease. 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