 In recent years, new-generation ECCO2R devices have been developed. They offer lower resistance to blood flow, have small priming volumes and have much more effective gas exchange. With ECCO2R the patients PaCO2 is principally determined by the rate of fresh gas flow through the membrane lung. In an ECCO2R animal model, CO2 removal averaged 721.2 mLmin at blood flows of 450 mLmin, while CO2 production by the lung decreased by 50 with reduction of minute ventilation from 5.6 Lmin at baseline to 2.6 Lmin after insertion of the device. Lastly, Terragni et al 15demonstrated that ECCO2R could improve pulmonary protection by allowing very low tidal volume ventilation 3.5-5 mlkg of PBW in a proof-of-concept study of ten patients with ARDS. This strategy was also associated with a significant decrease in pulmonary inflammatory biomarkers. 