*4.1.1 Evidence and clinical trials of ECCO2R in aeCOPD to date*

One of the first reports on the application of ECCO2R to support respiratory function of a COPD patient was published in 1990 by Pesenti et al. [36]. However, the technique was abandoned due to technical complications.

As the medical community regained interest in ECCO2R, investigators began applying the technique to prevent intubation or to assist weaning from the ventilator in patients with hypercapnic aeCOPD. Several studies in both VV and AV configurations were published, including a meta-analysis (**Table 2**).
