Recently, advancements in extracorporeal carbon dioxide removal (ECCO 2 R) technology have markedly enhanced its clinical applicability and efficacy for managing severe respiratory conditions. This review highlights critical innovations in ECCO 2 R, such as advanced catheter technologies, active mixing methods, and biochemical enhancements, which have substantially improved gas exchange efficiency and broadened the scope of ECCO 2 R applications. Integrating ECCO 2 R into acute and chronic respiratory care has led to a shift toward more mobile and less invasive modalities, promising for extending ECCO 2 R usage from intensive care units to home settings. By examining these technological advancements and their clinical impacts, this paper outlines the potential future directions of ECCO 2 R technology, emphasizing its role in transforming respiratory care practices and enhancing patient outcomes.