Extracorporeal carbon dioxide removal for the treatment of acute hypoxaemic respiratory failure: the REST RCT

• Published in: Health technology assessment (Winchester, England) Vol. 29; no. 33; pp. 1 - 16
• Main Authors: McNamee, James J, Agus, Ashley, Boyle, Andrew J, Jackson, Colette, McDowell, Cliona, Haglund, Jeanette, McAuley, Danny F
• Format: Journal Article
• Language: English
• Published: NIHR Journals Library 01.07.2025
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/GJDM0320

Many patients admitted to the intensive care unit need a breathing machine, or ventilator, to help them breathe and ensure that enough oxygen gets into their blood and carbon dioxide is removed. When people are critically ill, their lungs often fail; this is termed ‘acute respiratory failure’. Currently, there are no specific treatments other than placing the person on a ventilator to help bellow air in and out of the lungs, but this may damage the lungs and prevent healing and repair. There is currently a device called extracorporeal carbon dioxide removal, which could help ventilation by removing carbon dioxide from the blood and cause less damage to the lungs. We ran a study in intensive care units across the United Kingdom to compare extracorporeal carbon dioxide removal with standard care. We also wanted to find out if extracorporeal carbon dioxide removal reduced the time patients spent on a ventilator and in hospital, improved quality of life and was good value for money for the National Health Service. We aimed to recruit 1120 participants; however, the study closed early due to the extracorporeal carbon dioxide removal being found to be ineffective. From May 2016 to December 2019, we recruited 412 participants and randomly allocated them to be treated with extracorporeal carbon dioxide removal (202) or standard ventilation (210). In conclusion, the use of a device that removes carbon dioxide from the blood and allows for gentler mechanical ventilation of the lungs in adult patients had no effect on the death rate of patients after 90 days. There was also no effect on other short- or long-term outcomes. The device was associated with higher costs and potentially significant complications. We suggest this device is not used for routine care in patients with hypoxaemic respiratory failure, and if intensive care units are already using this device, they should consider discontinuing its use for this indication.