Abstract: Extracorporeal carbon dioxide removal (ECCO2R) is an emerging technique designed to reduce carbon dioxide (CO2) levels in venous blood while enabling lung-protective ventilation or alleviating the work of breathing. Despite encouraging results in controlling respiratory acidosis, its broader adoption is hindered by complications, including hemolysis, thrombosis, and bleeding. Technological advances, including enhanced membrane design, gas exchange efficiency and anticoagulation strategies, are essential to improving safety and efficacy ultimately enhancing the role of ECCO2R in critical care settings. 

Key words: Extracorporeal CO2 removal, Hypercapnia, Acute respiratory distress syndrome, Extracorporeal organ support, Continuous renal replacement therapy