**6. Conclusions**

In the past, ECCO2R was a complex technique requiring intensive monitoring and surgical expertise. Due to a high rate of complications, it was avoided by all but a few high expertise centers. With newer simplified system, devices are placed like temporary dialysis catheters and can be inserted by most intensivists.

In summary, minimally invasive ECCO2R appears very promising for patients with acute exacerbation of obstructive diseases refractory to conventional treatment, but systemic evaluation is needed to prove its efficacy and determine the actual risks.

#### **Acknowledgements**

We want to acknowledge Eduardo Radicy for creating the figure for this manuscript. He was not compensated for this work.
