Extracorporeal CO2 removal is feasible for ARDS: phase 2 SUPERNOVA

  • Combes A & al.
  • Intensive Care Med
  • 21 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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).

Limitations

  • May be underpowered to assess safety.
  • Authors unable to quantify clearance and total amount of CO2 removed, which are key efficacy measures.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit