58: Comparative Evaluation of Regular versus Customized ECCO2R Circuits in a Tertiary Care Centre of a Two-Tier City

Background: Extracorporeal CO2 Removal (ECCO2R) is an emerging adjunct therapy for managing refractory hypercapnia in severe ARDS and COPD exacerbations. However, conventional ECMO-based ECCO2R systems are expensive and often underutilized in resource-limited tertiary hospitals. To address this, a customized, low-cost ECCO2R circuit was developed and evaluated for feasibility in a two-tier tertiary care setting. Methods: A comparative observational study was conducted between a standard ECMO-based ECCO2R circuit and a customized circuit utilizing a pediatric oxygenator and roller pump. Parameters assessed included circuit priming time, blood flow (300–600 mL/min), CO2 removal efficiency (PaCO2 reduction), hemodynamic stability, and cost-effectiveness. Safety indices such as hemolysis and air entrainment were continuously monitored. Results: The customized ECCO2R circuit achieved an average PaCO2 reduction of 30 ± 5% within 2 hours, with stable hemodynamics and no major complications. The setup cost was reduced by approximately 50% compared to the standard system. The customized circuit required less priming volume and shorter setup time. Perfusionists could assemble the circuit using readily available hospital components. Limitations: This study was limited by a small sample size and short-term evaluation period; larger clinical validation is warranted to confirm long-term outcomes. Conclusion: Customized ECCO2R circuits represent a safe, feasible, and cost-effective alternative to standard ECMO-based systems in two-tier tertiary hospitals. This approach may expand access to advanced extracorporeal respiratory support in resource-limited regions without compromising safety or efficacy. Ethical Approval: Approved by the Institutional Ethics Committee, Narayana Medical College & Hospital (Ref. No: IEC/NMCH/PerfTech/2025/047).