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

Massimo Antonelli, A Combes, V Fanelli, T Pham, VM Ranieri, EC Goligher, D Brodie, A Pesenti, R Beale, L Brochard, JD Chiche, E Fan, D de Backer, G Francois, N Ferguson, J Laffey, A Mercat, DF McAuley, T Muller, M QuintelJL Vincent, FS Taccone, H Peperstraete, P Morimont, M Schmidt, B Levy, JL Diehl, C Guervilly, G Capelier, A Vieillard-Baron, J Messika, C Karagiannidis, O Moerer, R Urbino, F Mojoli, F Alessandri, G Grasselli, D Donker, R Ferrer, J Mancebo, AS Slutsky

Risultato della ricerca: Contributo in rivistaArticolo in rivista

Abstract

PurposeWe assessed feasibility and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate ultra-protective ventilation (V-T 4mL/kg and P(PLAT)25cmH(2)O) in patients with moderate acute respiratory distress syndrome (ARDS).MethodsProspective 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. 1.30m(2); flow 300-500mL/min vs. 800-1000mL/min, respectively).ResultsNinety-five patients were enrolled. The proportion of patients who achieved ultra-protective settings by 8h and 24h 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.ConclusionsUse of ECCO2R to facilitate ultra-protective ventilation was feasible. A randomized clinical trial is required to assess the overall benefits and harms.Clinicaltrials.govNCT02282657
Lingua originaleEnglish
pagine (da-a)592-600
Numero di pagine9
RivistaIntensive Care Medicine
Volume45
Stato di pubblicazionePubblicato - 2019

Keywords

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

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