Extracorporeal CO2 removal integrated with continuous renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: a systematic review and meta-analysis
Authors' conclusion
ECCO2R integrated with CRRT was associated with early PaCO2 reduction, pH improvement, and lower ventilatory intensity in patients with ARDS and AKI.
Study context
- Population
- Adults with acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT)
- Participants
- 105 adults · 7 observational studies
- Comparison
- ECCO2R integrated with CRRT, pre vs post treatment initiation
- Outcome
- Changes in PaCO2 and arterial pH after treatment initiation
Methodological detailspre-post analysis, random-effects models
- Pre-post analysis
- Random-effects models
Pooled result
As reported in the abstract
Change in PaCO2 and arterial pH (pre-post)
MD, mmHg (95% CI)
PaCO2 at 2 h
−8.22(−12.00 to −4.44)
PaCO2 at 6 h
−9.02(−15.69 to −2.34)
PaCO2 at 24 h
−9.10(−13.59 to −4.61)
- Arterial pH at 2 h
- MD + 0.05 (95% CI 0.02–0.08)
- Arterial pH at 24 h
- MD + 0.06 (95% CI 0.02–0.11)
Further pooled results
Ventilatory variables (pre-post)
| MD (mL/kg PBW) (95% CI) | ||
|---|---|---|
| Tidal volume normalized to predicted body weight | −1.14 (−1.74 to −0.54) | |
| −2−101Difference, mL/kg PBW (linear scale) |
| MD (cmH2O) (95% CI) | ||
|---|---|---|
| Driving pressure | −3.61 (−4.87 to −2.35) | |
| −6−4−202Difference, cmH2O (linear scale) |
| MD (J/min) (95% CI) | ||
|---|---|---|
| Mechanical power | −6.82 (−9.12 to −4.51) | |
| −10−505Difference, J/min (linear scale) |
Safety
Safety and patient-centred outcomes
- Limited and heterogeneously reported
Original publication
Extracorporeal CO2 removal integrated with continuous renal replacement therapy in patients with acute respiratory distress syndrome and acute kidney injury: a systematic review and meta-analysis. Ann Intensive Care. Published 15 July 2026. doi:10.
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