Optimizing CO 2 clearance in combined extracorporeal carbon dioxide removal and continuous renal replacement therapy: The role of bicarbonate and circuit configuration modality
Restricted accessLetterFirst published online 2026
Optimizing CO 2 clearance in combined extracorporeal carbon dioxide removal and continuous renal replacement therapy: The role of bicarbonate and circuit configuration modality
NentwichJWichmannDKlugeS, et al.Low-flow CO2 removal in combination with renal replacement therapy effectively reduces ventilation requirements in hypercapnic patients: a pilot study. Ann Intensive Care2019; 9(1): 3. https://doi.org/10.1186/s13613-019-0480-4
2.
ZanellaAPesentiABusanaM, et al.A minimally invasive and highly effective extracorporeal CO2 removal device combined with a continuous renal replacement therapy. Crit Care Med2022; 50(5): e468–e476. https://doi.org/10.1097/CCM.0000000000005428
3.
VivonaLBattistinMCarlessoE, et al.Hematocrit: the neglected variable of extracorporeal CO2 removal. Am J Respir Crit Care Med2024; 209(5): 595–598. https://doi.org/10.1164/rccm.202309-1697LE
4.
QianZZhangRWangY, et al.Effect of low bicarbonate substitution solution on CO2 removal rate in the combined system of extracorporeal CO2 removal and continuous renal replacement therapy. Intensive Care Med Exp2025; 13(1): 8. https://doi.org/10.1186/s40635-025-00827-8
5.
Allardet-ServentJCastanierMSignouretT, et al.Safety and efficacy of combined extracorporeal CO2 removal and renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: the pulmonary and renal support in acute respiratory distress syndrome study. Crit Care Med2015; 43(12): 2570–2581. https://doi.org/10.1097/CCM.0000000000001296
6.
CombesALevyBTapponnierR, et al.A prospective clinical evaluation of new ECCO2R technology in mild to moderate ARDS patients: assessing ultra-lung-protective ventilation with PRISMALUNG+. Crit Care2026; 30: 15. https://doi.org/10.1186/s13054-025-05827-4
7.
AmmannKROutridgeCERoka-MoiiaY, et al.Sodium bicarbonate as a local adjunctive agent for limiting platelet activation, aggregation, and adhesion within cardiovascular therapeutic devices. J Thromb Thrombolysis2023; 56(3): 398–410. https://doi.org/10.1007/s11239-023-02852-4
8.
CoveMEVuLHRingT, et al.Respiratory Dialysis-A novel low bicarbonate dialysate to provide extracorporeal CO2 removal. Crit Care Med2020; 48(7): e592–e598. https://doi.org/10.1097/CCM.0000000000004351
9.
MiyagawaRHamaguchiJAibaraK, et al.Use of double-parallel oxygenators for Hypercapnia during veno-venous extracorporeal membrane oxygenation: a case report. Cureus2025; 17(2): e79757, Published 2025 Feb 27. https://doi.org/10.7759/cureus.79757
10.
FlorioGValsecchiCVivonaL, et al.Enhanced extracorporeal carbon dioxide removal by acidification and metabolic control. Minerva Anestesiol2023; 89(9): 773–782. https://doi.org/10.23736/S0375-9393.23.17142-2
11.
VivonaLBattistinMCarlessoE, et al.Alkaline liquid ventilation of the membrane lung for extracorporeal carbon dioxide removal (ECCO2R): in vitro study. Membranes2021; 11(7): 464, Published 2021 Jun 22. https://doi.org/10.3390/membranes11070464
12.
ConsalesGZamideiLTuraniF, et al.Combined renal-pulmonary extracorporeal support with low blood flow techniques: a retrospective observational study (CICERO study). Blood Purif2022; 51(4): 299–308. https://doi.org/10.1159/000517280