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Intensive Care Med. 2019 Feb 21. doi: 10.1007/s00134-019-05567-4. [Epub ahead of print]

Feasibility and safety of extracorporeal CO2 removal to enhance protective ventilation in acute respiratory distress syndrome: the SUPERNOVA study.

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Institute of Cardio-metabolism and Nutrition, and Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
Città della Salute e della Scienza di Torino, Department of Anesthesia and Intensive Care Medicine, University of Turin, Turin, Italy.
Keenan Research Center of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
Alma Mater Studiorum - Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Via Massarenti, 9, 40138, Bologna, Italy.



We assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate ultra-protective ventilation (VT 4 mL/kg and PPLAT ≤ 25 cmH2O) in patients with moderate acute respiratory distress syndrome (ARDS).


Prospective multicenter international phase 2 study. Primary endpoint was the proportion of patients achieving ultra-protective ventilation with PaCO2 not increasing more than 20% from baseline, and arterial pH > 7.30. Severe adverse events (SAE) and ECCO2R-related adverse events (ECCO2R-AE) were reported to an independent data and safety monitoring board. We used lower CO2 extraction and higher CO2 extraction devices (membrane lung cross-sectional area 0.59 vs. 1.30 m2; flow 300-500 mL/min vs. 800-1000 mL/min, respectively).


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. ECCO2R was maintained for 5 [3-8] days. Six SAEs were reported; two of them were attributed to ECCO2R (brain hemorrhage and pneumothorax). ECCO2R-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.


Use of ECCO2R to facilitate ultra-protective ventilation was feasible. A randomized clinical trial is required to assess the overall benefits and harms. CLINICALTRIALS.GOV: NCT02282657.


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


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