ProLUNG® is the reference system for Low Flow Extracorporeal CO2 Removal (LF-ECCO2R), providing high CO2 removal (VCO2 > 100 ml/min), very low invasiveness, and real-time monitoring of CO2 removal by use of the ProLUNG® Meter. LF-ECCO2R is a minimally invasive extracorporeal support treatment aiming to achieve optimal ventilation by reducing CO2 amounts while securing low invasiveness for the patient.

The following are examples in which low-flow venovenous extracorporeal CO2 removal treatment can be applied:

  1. MODERATE ARDS– In patients with ARDS (see Table 1 for the definition of ARDS) and severe hypercapnia refractory to protective mechanical ventilation, extracorporeal removal of CO2allows to limit plateau pressure and tidal volume, otherwise necessary to control respiratory acidosis, but harmful to the lungs (barotrauma and volutrauma).
  2. COPD EXACERBATIONS– During an exacerbation of the disease, in patients with respiratory acidosis refractory to support NIV, extracorporeal elimination of CO2 can extend the application of non-invasive support, avoiding intubation and possible related infectious complications, prolonged length of stay in ICU, prolonged hospital length of stay, worse outcome, as well as to perform fast weaning from mechanical ventilation in patients already intubated during the last 24-48 hours.
  3. LUNG TRANSPLANTATION– In the pre-, intra-, and post-operative period, in patients who develop hypercapnic ARF due to terminal organ life or primary graft dysfunction associated with severe hypercapnia, extracorporeal removal of CO2 allows limiting pressure and volume of ventilatory support, otherwise associated with ventilator-induced injury.
  4. TISSUE LESIONS– Certain conditions, like bronchopleural fistula, damage of the trachea, or lesions of the diaphragm are affected by the continuous inhalation and exhalation phases of thoracic activity. Moreover, high blood pressure in the airways during ventilatory support has a negative influence on the damage that already exists. In these cases, the use of extracorporeal removal of CO2 at low flows may be critical for a protective ventilation scheme.
  5. COVID-19 – in case of difficulty managing protective or ultraprotective ventilation, ECCO2R can be effective in reducing the risk of ventilator-induced lung injury (VILI)
Table 1. Berlin definition of ARDS (2012)



The ProLUNG® system consists of a v hemoperfusion circuit with a gas exchanger device (ProLUNG® – surface of 1.8 m2 of polymethylpentene membrane coated with phosphorylcholine). Medical air is used as a gas source to remove CO2 from blood across the membrane. The system can reach 450 ml/min and a double-lumen central venous catheter (13.5 Fr) can be placed in the femoral, subclavian, or jugular vein. The invasiveness of the system is comparable to a standard CRRT technique.

ProLUNG® Meter is a platform for automated management of airflow and monitoring CO2 removal during extracorporeal hemoperfusion treatment. The ProLUNG® Meter allows the clinician to adjust the airflow, warm it, and read the VCO2 in real-time.