6/29/23, 1:12 AM REST Pathway Feedback Search Clinical Topics Home Studies REST REST Trial question What is the effect of lower tidal volume ventilation facilitated by extracorporeal CO2 removal in patients with acute hypoxemic respiratory failure? Study design Multi-center Open label RCT Population Characteristics of study participants 35.0% female N = 412 65.0% male 412 patients (143 female, 269 male) Inclusion criteria: adult patients receiving mechanical ventilation for acute hypoxemic respiratory failure Key exclusion criteria: receipt of invasive mechanical ventilation > 7 days, contraindication to limited systemic anticoagulation with heparin, untreated PE, pleural effusion, pneumothorax, or LV failure or fluid overload Interventions N=202 extracorporeal CO2 removal (lower tidal volume ventilation facilitated by extracorporeal CO2 removal for at least 48 hours) N=210 standard care (standard care with conventional low tidal volume ventilation) Primary outcome Death from all causes at 90 days 41.5 % 41.5 39.5 31.1 % 20.8 % https://web.pathway.md/studies/reciheXMQpjy8eKPB 1/2 6/29/23, 1:12 AM 20.8 % REST Pathway 10.4 % No significant difference 0.0 % Extracorporeal carbon dioxide removal Standard care No significant difference in death from all causes at 90 days (41.5% vs. 39.5%; RR 1.05, 95% CI 0.83 to 1.33) Secondary outcomes Significant decrease in ventilator-free days (7.1 days vs. 9.2 days; AD -2.1 days, 95% CI -3.8 to -0.3) No significant difference in the rate of need for ECMO to day 7 (6% vs. 3%; RR 2.08, 95% CI 0.8 to 5.43) No significant difference in death at day 28 (38% vs. 36%; RR 1.06, 95% CI 0.82 to 1.37) Safety outcomes No significant differences in duration of ventilation, adverse events. Conclusion In adult patients receiving mechanical ventilation for acute hypoxemic respiratory failure, extracorporeal CO2 removal was not superior to standard care with respect to death from all causes at 90 days. Reference James J McNamee, Michael A Gillies, Nicholas A Barrett et al. Effect of Lower Tidal Volume Ventilation Facilitated by Extracorporeal Carbon Dioxide Removal vs Standard Care Ventilation on 90-Day Mortality in Patients With Acute Hypoxemic Respiratory Failure: The REST Randomized Clinical Trial. JAMA. 2021 Sep 21;326(11):1013-1023. Open reference URL https://web.pathway.md/studies/reciheXMQpjy8eKPB 2/2