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

Intensive Care Medicine
Alain CombesEuropean Society of Intensive Care Medicine Trials Group and the “Strategy of Ultra-Protective lung ventilation with Extraco

Abstract

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 ...Continue Reading

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Citations

Aug 14, 2019·JAMA : the Journal of the American Medical Association·Daniel BrodieAlain Combes
Aug 23, 2019·Intensive Care Medicine·Ewan C GoligherUNKNOWN SUPERNOVA investigators (European Society of Intensive Care Medicine trials group)  and for the International ECMO Network (
Nov 7, 2019·Critical Care : the Official Journal of the Critical Care Forum·Sascha Gross-HardtChristian Karagiannidis
Nov 15, 2019·American Journal of Respiratory and Critical Care Medicine·Darryl AbramsDaniel Brodie
Feb 25, 2020·Expert Review of Respiratory Medicine·Soo Jin Na, Kyeongman Jeon
Sep 26, 2019·American Journal of Respiratory and Critical Care Medicine·Alberto ZanellaAntonio M Pesenti
Mar 10, 2020·Anesthesiology·Michael QuintelLuciano Gattinoni
Apr 19, 2020·Critical Care Medicine·Matthew E CoveJohn A Kellum
Jul 18, 2019·American Journal of Respiratory and Critical Care Medicine·Darya RudymDarryl Abrams
Mar 13, 2020·Intensive Care Medicine·Luciano GattinoniJohn J Marini
May 15, 2020·Intensive Care Medicine Experimental·Ingeborg HospachMarkus Storr
Aug 10, 2020·Critical Care : the Official Journal of the Critical Care Forum·Alain CombesKai Harenski
Jun 16, 2019·Critical Care : the Official Journal of the Critical Care Forum·L GattinoniM Quintel
Dec 27, 2019·Current Opinion in Critical Care·Elena SpinelliTommaso Mauri
Apr 19, 2020·Critical Care : the Official Journal of the Critical Care Forum·Edoardo PicettiUNKNOWN on the behalf of the ESICM NIC/ARF sections
Jul 28, 2019·Intensive Care Medicine Experimental·Luis Morales-QuinterosAntonio Artigas
May 22, 2019·Intensive Care Medicine·Thomas BeinAnders Perner
Feb 26, 2020·Medizinische Klinik, Intensivmedizin und Notfallmedizin·W Huber, A P Ruiz de Garibay
Oct 31, 2019·BioMed Research International·Diamanto ArethaGregorios Voyagis
Mar 7, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Alexandra G MayWilliam J Federspiel
Nov 7, 2020·Intensive Care Medicine·Mario MenkNiall D Ferguson
Jan 7, 2021·Journal of Translational Medicine·Malte SchöpsChristian Karagiannidis
Nov 4, 2020·Intensive Care Medicine·Alain CombesDaniel Brodie
Dec 31, 2020·Membranes·Matteo Di NardoFabio Silvio Taccone
Feb 21, 2021·Seminars in Dialysis·Emily SeeRinaldo Bellomo
Feb 24, 2020·Chest·Abhijit DuggalUNKNOWN LUNG SAFE Investigators and the ESICM Trials Group
Nov 3, 2020·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Alexandra G MayWilliam J Federspiel
Feb 26, 2021·Interface Focus·Claire MastersonDaniel O'Toole

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