Abstract

Introduction: The combination of Extracorporeal Carbon Dioxide Removal (ECCO₂R) with Continuous Renal Replacement Therapy (CRRT) represents an essential therapeutic approach for treating hypercapnic respiratory failure and multi-organ dysfunction in critically ill patients. This protocol-based study outlines the implementation of a standardized combined ECCO₂R-CRRT strategy in a critical care setting using the PrismaLung platform.
Methods: We established a comprehensive protocol addressing patient selection criteria, cannulation methods, device settings, and anticoagulation protocols and strategies for managing complications during ECCO₂R-CRRT therapy. The protocol was developed through evidence-based and expert consensus methods to treat patients who have concurrent
respiratory and renal failure.
Results: The protocol defines specific inclusion criteria for ARDS patients (driving pressure >14 cmH₂O, plateau pressure >25 cmH₂O), COPD exacerbations (pH <7.25, PaCO₂ >70 mmHg), and concurrent renal failure requiring CRRT. The technical specifications include dual-lumen catheters (≥13F), blood flow rates of 350-450 mL/min, and sweep gas flow of 2-10 L/min. The anticoagulation strategy with systematic monitoring protocols.
Conclusion: The implementation of a structured ECCO₂R-CRRT protocol using PrismaLung in ICU settings proves safe for specific patient populations. This combined approach provides simultaneous lung and kidney protective support and may reduce ventilator dependence in hypercapnic respiratory failure with concurrent renal dysfunction. The safety concerns associated with standalone ECCO₂R machines must be re-evaluated in integrated ECCO₂R- CRRT utilizing this novel protocol.

Keywords

CRRT, ARDS, hypercapnia, lung protective ventilation, PrismaLung, extracorporeal support