Extracorporeal carbon dioxide removal (ECCO

Extracorporeal carbon dioxide removal (ECCO2R) has emerged as a promising adjunctive therapy to mitigate hypercapnia and reduce invasive mechanical ventilation (IMV) settings. We present the cases of two post-lung transplant patients with severe hypercapnia and respiratory failure who were successfully treated with the ECCO2R. In both cases, we used a venovenous ECCO2R (V-ECCO2R) system, employing the Prismalung™ oxygenator integrated into a Prismaflex™ continuous renal replacement therapy (CRRT) platform. This technique proved efficacy in correcting hypercapnia, improving ventilatory parameters, and facilitating lung-protective strategies in post-lung transplant patients with respiratory failure. This technique represents a valuable adjunct to conventional mechanical ventilation, particularly in cases where hypercapnia poses a risk to graft function and patient stability. Further studies are warranted to establish optimal patient selection and refine treatment protocols for ECCO2R implementation in critical care settings.