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Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study
  1. Alain Combes1,
  2. Tommaso Tonetti2,
  3. Vito Fanelli3,
  4. Tai Pham4,
  5. Antonio Pesenti5,6,
  6. Jordi Mancebo7,
  7. Daniel Brodie8,
  8. V Marco Ranieri9
  1. 1 Hôpital Universitaire Pitié Salpêtrière, Paris, Île-de-France, France
  2. 2 Department of Anesthesiology, Georg-August-Universitat Göttingen, Göttingen, Germany
  3. 3 Università degli Studi di Torino, Turin, Italy
  4. 4 Hôpital Tenon, Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Assistance Publique—Hopitaux de Paris, Paris, France
  5. 5 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
  6. 6 Department of Anesthesia, Critical Care and Emergency, La Fondazione IRCCS Ospedale Maggiore Policlinico Mangiagalli e Regina Elena, Milan, Italy
  7. 7 Hospital de la Santa Creu i Sant Pau Institut de Recerca, Barcelona, Spain
  8. 8 New York-Presbyterian Hospital/Columbia University Medical Center, New York City, New York, USA
  9. 9 Policlinico di Sant’Orsola, Anesthesia and Intensive Care Medicine, Università degli Studi di Bologna, Bologna, Italy
  1. Correspondence to Professor V Marco Ranieri, Policlinico di Sant'Orsola, Anesthesia and Intensive Care Medicine, Università degli Studi di Bologna, Bologna, Italy; m.ranieri{at}


Retrospective analysis of the SUPERNOVA trial exploring the hypothesis that efficacy and safety of extracorporeal carbon dioxide removal (ECCO2R) to facilitate reduction of tidal volume (VT) to 4 mL/kg in patients with acute respiratory distress syndrome (ARDS) may differ between systems with lower (area of membrane length 0.59 m2; blood flow 300–500 mL/min) and higher (membrane area 1.30 m2; blood flow between 800 and 1000 mL/min) CO2 extraction capacity. Ninety-five patients with moderate ARDS were included (33 patients treated with lower and 62 patients treated with higher CO2 extraction devices). We found that (1) VT 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 ECCO2R-related haemolysis and bleeding was higher with lower than with higher extraction devices (21% vs 6%, p=0.045% and 27% vs 6%, p=0.010, respectively). Although V T 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 higher CO2 extraction capacity.

  • acute respiratory distress syndrome
  • mechanical ventilation
  • extracorporeal carbon dioxide removal
  • ventilator-induced lung injury

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  • Funding This study was supported by the European Society of Intensive Care Medicine (ESICM).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.