Feasibility and safety of extracorporeal CO 2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study

On behalf of the European Society of Intensive Care Medicine Trials Group and the “Strategy of Ultra-Protective lung ventilation with Extracorporeal CO2 Removal for New-Onset moderate to severe ARDS” (SUPERNOVA) investigators

Research output: Contribution to journalArticleAcademicpeer-review

85 Citations (Scopus)

Abstract

Purpose: We assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO 2 R) to facilitate ultra-protective ventilation (V T 4 mL/kg and P PLAT ≤ 25 cmH 2 O) in patients with moderate acute respiratory distress syndrome (ARDS). Methods: Prospective multicenter international phase 2 study. Primary endpoint was the proportion of patients achieving ultra-protective ventilation with PaCO 2 not increasing more than 20% from baseline, and arterial pH > 7.30. Severe adverse events (SAE) and ECCO 2 R-related adverse events (ECCO 2 R-AE) were reported to an independent data and safety monitoring board. We used lower CO 2 extraction and higher CO 2 extraction devices (membrane lung cross-sectional area 0.59 vs. 1.30 m 2 ; flow 300–500 mL/min vs. 800–1000 mL/min, respectively). Results: Ninety-five patients were enrolled. The proportion of patients who achieved ultra-protective settings by 8 h and 24 h was 78% (74 out of 95 patients; 95% confidence interval 68–89%) and 82% (78 out of 95 patients; 95% confidence interval 76–88%), respectively. ECCO 2 R was maintained for 5 [3–8] days. Six SAEs were reported; two of them were attributed to ECCO 2 R (brain hemorrhage and pneumothorax). ECCO 2 R-AEs were reported in 39% of the patients. A total of 69 patients (73%) were alive at day 28. Fifty-nine patients (62%) were alive at hospital discharge. Conclusions: Use of ECCO 2 R to facilitate ultra-protective ventilation was feasible. A randomized clinical trial is required to assess the overall benefits and harms. Clinicaltrials.gov: NCT02282657.

Original languageEnglish
Pages (from-to)592-600
Number of pages9
JournalIntensive care medicine
Volume45
Issue number5
DOIs
Publication statusPublished - 1 May 2019
Externally publishedYes

Keywords

  • Acute respiratory distress syndrome
  • Extracorporeal carbon dioxide removal
  • Mechanical ventilation
  • Ventilator-induced lung injury

Fingerprint

Dive into the research topics of 'Feasibility and safety of extracorporeal CO <sub>2</sub> removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study'. Together they form a unique fingerprint.

Cite this