Case Report

Extracorporeal carbon dioxide removal (ECCO₂R) in post lung transplant patients

¹ Internal Medicine Residents, Department of Health Sciences, Christus Muguerza Health System, UDEM, Monterrey, Nuevo León, México
² Clinical Director, Lung Transplant Program. Christus Muguerza Alta Especialidad, Monterrey, México
³ Cardiothoracic and Lung Transplant Surgeon, Lung Transplant Program. Christus Muguerza Alta Especialidad, Monterrey, México
⁴ Infectology Lung Transplant Program, Christus Muguerza Alta Especialidad, Monterrey, México
⁵ Nephrology of the Critically Ill Patient, Internal Medicine, Internal Medicine Professor, Department of Health Sciences, Christus Muguerza Health System, Monterrey, Nuevo León, México
⁶ Pulmonary and Critical Care Medicine, Lung Transplant Program, Christus Muguerza Alta Especialidad, Monterrey, México

^* Corresponding author: This email address is being protected from spambots. You need JavaScript enabled to view it.

Received: 28 March 2025
Accepted: 12 October 2025

Abstract

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.