RT Journal Article SR Electronic T1 Efficacy and safety of lower versus higher CO2 extraction devices to allow ultraprotective ventilation: secondary analysis of the SUPERNOVA study JF Thorax JO Thorax FD BMJ Publishing Group Ltd and British Thoracic Society SP thoraxjnl-2019-213591 DO 10.1136/thoraxjnl-2019-213591 A1 Alain Combes A1 Tommaso Tonetti A1 Vito Fanelli A1 Tai Pham A1 Antonio Pesenti A1 Jordi Mancebo A1 Daniel Brodie A1 V Marco Ranieri YR 2019 UL http://thorax.bmj.com/content/early/2019/08/13/thoraxjnl-2019-213591.abstract AB 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.