Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France.
Department of Anesthesiology, Georg-August-Universitat Göttingen, Göttingen, Germany.
Thorax. 2019 Dec;74(12):1179-1181. doi: 10.1136/thoraxjnl-2019-213591. Epub 2019 Aug 13.
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.
回顾性分析 SUPERNOVA 试验，该试验旨在验证以下假说：体外二氧化碳去除（ECCOR）的疗效和安全性可能因 CO 提取能力不同的系统而异，这些系统分别为[面积为 0.59m 的膜；血流 300-500mL/min]和[膜面积 1.30m；血流 800-1000mL/min]的 CO 提取设备，以帮助急性呼吸窘迫综合征（ARDS）患者将潮气量（V）降低至 4ml/kg。该试验纳入了 95 例中度 ARDS 患者（33 例接受[面积为 0.59m 的膜；血流 300-500mL/min]CO 提取设备治疗，62 例接受[膜面积 1.30m；血流 800-1000mL/min]CO 提取设备治疗）。结果发现：（1）与低提取组相比，高提取组分别在 8 小时和 24 小时时达到 4ml/kg 的 V 的患者比例更高（分别为 55%和 64% vs 90%和 92%，p<0.001）；（2）与高提取组相比，低提取组发生 ECCOR 相关溶血性和出血性不良事件的患者比例更高（分别为 21% vs 6%，p=0.045%和 27% vs 6%，p=0.010）。尽管所有设备都能达到 4ml/kg 的 V，但高提取 CO 能力的设备更频繁且不良反应发生率更低地达到了这一目标。
