- For patients with moderate acute respiratory distress syndrome (ARDS), extracorporeal carbon dioxide removal (ECCO2R) reduces respiratory acidosis.
- Risks vs benefits unclear; randomized controlled trial needed.
Why this matters
- Ventilator settings that reduce risk for lung injury can result in severe respiratory acidosis.
- ECCO2R offsets lung acid load, but few data are available.
- Percentage achieving primary outcome (95% CIs) at:
- 8 hours: 78% (68%-89%; 74/95).
- 24 hours: 82% (76%-88%; 78/95).
- Over first 24 hours:
- PaCO2 and PaO2/FiO2 remained similar to baseline.
- pH increased at 8 hours (P<.05 and hours>
- 26 patients experienced adverse events in first 24 hours.
- Of 6 serious adverse events, 2 were attributed to ECCO2R.
- Prospective multicenter international phase 2 feasibility and safety SUPERNOVA study (n=95).
- Adults with moderate ARDS who required mechanical ventilation underwent ECCO2R for 5 days with any of 3 devices.
- Outcome: proportion of patients achieving ultraprotective ventilation with PaCO2 increasing ≤20% vs baseline and arterial pH >7.3.
- Funding: Alung Technologies Inc.; Maquet (Getinge Group); Novalung (Fresenius Medical).
- May be underpowered to assess safety.
- Authors unable to quantify clearance and total amount of CO2 removed, which are key efficacy measures.