biostudies-literatureUnknown12Zhen W<h4>Background</h4>Although low tidal volume ventilation has been shown to reduce mortality in patients with acute respiratory distress syndrome (ARDS), overall mortality remains high (30%-40%). Ultra-protective ventilation (≤4 mL/kg predicted body weight) has the potential to further decrease ventilator-induced lung injury but may result in severe hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) could facilitate ultra-protective ventilation by alleviating carbon dioxide retention; however, supporting evidence remains limited.<h4>Objective</h4>To evaluate the efficacy of ECCO₂R in enabling ultra-protective ventilation strategies in patients with ARDS.<h4>Methods</h4>A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane LibrarFrontiers in medicine1707596https://www.ebi.ac.uk/biostudies/studies/S-EPMC12648385biostudies-literatureEffects of extracorporeal carbon dioxide removal in facilitating ultra-protective ventilation strategies for patients with acute respiratory distress syndrome: a systematic review and meta-analysis.PMC12648385Zhen WZhu YZhang XShi ZfalseEffects of extracorporeal carbon dioxide removal in facilitating ultra-protective ventilation strategies for patients with acute respiratory distress syndrome: a systematic review and meta-analysis.<h4>Background</h4>Although low tidal volume ventilation has been shown to reduce mortality in patients with acute respiratory distress syndrome (ARDS), overall mortality remains high (30%-40%). Ultra-protective ventilation (≤4 mL/kg predicted body weight) has the potential to further decrease ventilator-induced lung injury but may result in severe hypercapnia. Extracorporeal carbon dioxide removal (ECCO₂R) could facilitate ultra-protective ventilation by alleviating carbon dioxide retention; however, supporting evidence remains limited.<h4>Objective</h4>To evaluate the efficacy of ECCO₂R in enabling ultra-protective ventilation strategies in patients with ARDS.<h4>Methods</h4>A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Librar2025-01-01T00:00:00Z20252026-06-05T16:40:29.31Z2026-06-05T03:06:52.821ZS-EPMC126483854131246810.3389/fmed.2025.1707596