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Background: In this retrospective study, we report the effectiveness and safety of a dedicated extracorporeal carbon dioxide removal (ECCO₂R) device in critically ill patients. Methods: Adult patients on mechanical ventilation due to acute respiratory distress syndrome (ARDS) or decompensated chronic obstructive pulmonary disease (dCOPD), who were treated with a dedicated ECCO₂R device (CO2RESET, Eurosets, Medolla, Italy) in case of hypercapnic acidemia, were included. Repeated measurements of CO₂ removal (VCO₂) at baseline and 1, 12, and 24 h after the initiation of therapy were recorded. Results: Over a three-year period, 11 patients received ECCO₂R (median age 60 [43–72] years) 3 (2–39) days after ICU admission; nine patients had ARDS and two had dCOPD. Median baseline pH and PaCO₂ levels were 7.27 (7.12–7.33) and 65 (50–84) mmHg, respectively. With a median ECCO₂R blood flow of 800 (500–800) mL/min and maximum gas flow of 6 (2–14) L/min, the VCO₂ at 12 h after ECCO₂R initiation was 157 (58–183) mL/min. Tidal volume, respiratory rate, and driving pressure were significantly reduced over time. Few side effects were reported. Conclusions: In this study, a dedicated ECCO₂R device provided a high VCO₂ with a favorable risk profile.