Efficacy and safety of lower versus higher CO extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study.

Retrospective analysis of the SUPERNOVA trial exploring the hypothesis that efficacy and safety of extracorporeal carbon dioxide removal (ECCOR) to facilitate reduction of tidal volume (V) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with (area of membrane length 0.59 m; blood flow 300-500 mL/min) and (membrane area 1.30 m; blood flow between 800 and 1000 mL/min) CO extraction capacity. Ninety-five patients with moderate ARDS were included (33 patients treated with and 62 patients treated with CO extraction devices). We found that (1) V of 4 mL/kg was reached by 55% and 64% of patients with the lower extraction versus 90% and 92% of patients with higher extraction devices at 8 and 24 hours from baseline, respectively (p<0.001), and (2) percentage of patients experiencing episodes of ECCOR-related haemolysis and bleeding was higher with than with extraction devices (21% vs 6%, p=0.045% and 27% vs 6%, p=0.010, respectively). Although V of 4 mL/kg could have been obtained with all devices, this was achieved frequently and with a lower rate of adverse events by devices with CO extraction capacity.