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A non-systematic literature review (PubMed, Medline, Embase, Google Scholar; January 2000\u2013November 2024) identified randomized-controlled-trials (RCTs) and real-world evidence (RWE) on ECCO<jats:sub>2<\/jats:sub>R, alone or combined with continuous renal replacement therapy (CRRT). A multidisciplinary panel of intensivists, anesthesiologists, and nephrologists from Italy, Portugal, and Spain assessed clinical integration of ECCO<jats:sub>2<\/jats:sub>R. Key considerations included identifying ideal candidates, such as patients with acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), asthma exacerbations, alongside initiation timing and discontinuation criteria. For ARDS, recommended initiation thresholds included driving pressure \u226515 cm H<jats:sub>2<\/jats:sub>O, plateau pressure \u226528 cm H<jats:sub>2<\/jats:sub>O, pH &amp;lt; 7.28, and respiratory-rate &amp;gt;25 breaths\/min. In COPD or asthma exacerbations at risk of non-invasive ventilation (NIV) failure, triggers included pH \u2264 7.25, RR \u2265 30 breaths\/min, Intrinsic-PEEP \u2265 5 cm H<jats:sub>2<\/jats:sub>O, signs of respiratory fatigue, paradoxical abdominal motion, and severe distress. Absolute contraindications were uncontrolled bleeding, refractory hemodynamic instability, or lack of vascular access. Relative contraindications included moderate coagulopathy and limited access. 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