**3.3 CO2 removal in the bridge-to-transplant population**

In patients awaiting lung transplantation, adequate gas exchange may not be sufficiently achieved by ventilation alone if acute respiratory decompensation arises. This may result in a life-threatening hypercapnia. ECMO may serve an additional purpose in patients bridging to lung transplantation as an adjunct for CO2 removal (ECCO2-R). For some patients, increased CO2 clearance may spare them the need for mechanical ventilation [28]. A 2016 study of 20 patients (15 invasively ventilated and five noninvasively ventilated patients) demonstrated effective correction of hypercapnia and acidosis within the first 12 hours of therapy. Nineteen patients were successfully transplanted, and hospital and 1-year survival was 75 and 72%, respectively. This highlights ECCO2-R as a feasible rescue therapy that can be associated with high transplantation and survival rates [29].
