Automated inhaled nitric oxide alerts for adult extracorporeal membrane oxygenation patient identification

Belenkiy, Slava; Batchinsky, Andriy I.; Park, Timothy S.; Luellen, David; Serio-Melvin, Maria; Cancio, Leopoldo C.; Pamplin, Jeremy; Chung, Kevin K.; Salinas, José; Cannon, Jeremy W.

doi:10.1097/ta.0000000000000343

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…In the past NO has been reported as an indicator for considering the need of ECMO therapy in polytrauma patients. 27 , 31 In our case series, eight out of 19 patients were also treated with NO, but there was no difference in outcome. Due to the dilative effect of NO on the pulmonary vasculature and its related improvement of the blood flow it could improve oxygenation in uninjured lung areas.…”

Section: Discussionmentioning

confidence: 57%

Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series

et al. 2021

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Background: Thoracic trauma is the most common injury in polytrauma patients. Often associated with the development of an acute respiratory distress syndrome (ARDS), conservative treatment options are very restricted and reach their limits quickly. Objective: Extracorporeal membrane oxygenation (ECMO) is a wellestablished therapy in cardio-thoracic surgery and internal medicine intensive care units. The purpose of this study is to analyse the potential benefit of ECMO therapy in ARDS treatment in polytrauma patients. Design: Retrospective case series. Setting: Level 1 trauma centre, Germany, 04/2011-04/2019. Patients: Nineteen patients with ARDS treated with a veno-venous ECMO system. Main outcome measures: This study focused on the time leading to therapy initiation, the severity of thoracic and overall injury. The Sequential Organ Failure Assessment (SOFA) Score, the Murray Score, the Abbreviated Injury Scale (AIS) 2005 level and the Injury Severity Score (ISS) were analysed. The results were analysed regarding survival and death. Results: The survival rate was 53%. The ISS was the same for survivors and deceased patients ( p = 0.604). Early initiation of ECMO therapy showed a significant trend for survivors ( p = 0.071). The SOFA Score level before ECMO therapy was significantly lower in the survivors than in those who died ( p = 0.035). The AISThorax level for survivors showed a significantly higher score level than the one for deceased patients ( p = 0.05). Conclusion: ECMO therapy in polytrauma patients is a safe and effective option, in particular when used early in ARDS treatment. The overall severity of organ failure determined the likelihood of survival rather than the thoracic trauma itself.

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Section: Discussionmentioning

confidence: 57%

Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series

et al. 2021

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“…Largely due to bleeding concerns associated with systemic anticoagulation, the use of ECLS in trauma has traditionally been uncommon despite 12% to 25% of injured patients developing ARDS, potentially as a result of pulmonary contusions or transfusion-related acute lung injury 15 . More recently, thoracic trauma has been recognized as a potential indication for V-V ECLS, with triggers such as hypoxemia (Pa o 2 /FIO 2 < 80 mmHg), hypercapnic failure (pH <7.25), and inhaled nitric oxide being used to support decision-making 16,17 . Technological changes, such as heparin-bonded circuits and cannulas, centrifugal pumps, and polymethyl-pentene oxygenators, have facilitated ECLS protocols that are less dependent on systemic anticoagulation, mitigating some of the concerns associated with the application of ECLS in trauma.…”

Section: Discussionmentioning

confidence: 99%

“…15 More recently, thoracic trauma has been recognized as a potential indication for V-V ECLS, with triggers such as hypoxemia (PaO 2 /FIO 2 < 80 mmHg), hypercapnic failure (pH <7.25), and inhaled nitric oxide being used to support decision-making. 16,17 Technological changes, such as heparin-bonded circuits and cannulas, centrifugal pumps, and polymethyl-pentene oxygenators, have facilitated ECLS protocols that are less dependent on systemic anticoagulation, mitigating some of the concerns associated with the application of ECLS in trauma. Indeed, several case series have been published whereby ECLS has been successfully run without systemic anticoagulation, sometimes for several days.…”

Section: Indication 1: Gas Exchange For Lung Injurymentioning

confidence: 99%

Extracorporeal life support in trauma: Indications and techniques

Lee,

Romano,

Tansley

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND Clarity about indications and techniques in extracorporeal life support (ECLS) in trauma is essential for timely and effective deployment, and to ensure good stewardship of an important resource. Extracorporeal life support deployments in a tertiary trauma center were reviewed to understand the indications, strategies, and tactics of ECLS in trauma. METHODS The provincial trauma registry was used to identify patients who received ECLS at a Level I trauma center and ECLS organization–accredited site between January 2014 and February 2021. Charts were reviewed for indications, technical factors, and outcomes following ECLS deployment. Based on this data, consensus around indications and techniques for ECLS in trauma was reached and refined by a multidisciplinary team discussion. RESULTS A total of 25 patients underwent ECLS as part of a comprehensive trauma resuscitation strategy. Eighteen patients underwent venovenous ECLS and seven received venoarterial ECLS. Nineteen patients survived the ECLS run, of which 15 survived to discharge. Four patients developed vascular injuries secondary to cannula insertion while four patients developed circuit clots. On multidisciplinary consensus, three broad indications for ECLS and their respective techniques were described: gas exchange for lung injury, extended damage control for severe injuries associated with the lethal triad, and circulatory support for cardiogenic shock or hypothermia. CONCLUSION The three broad indications for ECLS in trauma (gas exchange, extended damage control and circulatory support) require specific advanced planning and standardization of corresponding techniques (cannulation, circuit configuration, anticoagulation, and duration). When appropriately and effectively integrated into the trauma response, ECLS can extend the damage control paradigm to enable the management of complex multisystem injuries. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.

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“…e-alert. We postulate that this may be related to the complexity of interpreting chest radiograph reports with natural language processing, difficulty deriving ventilator settings from EHRs, or difficulty in accurately determining the beginning of acute lung injury or worsening of ARDS (e.g., initiation of inhaled nitric oxide as a marker for severe ARDS), which has been shown in other studies (28)(29)(30). However, Blum and colleagues developed automated alerting for the early identification of acute lung injury, and this resulted in significant reduction in the tidal volume administered compared with control subjects (31).…”

Section: Brief Communicationmentioning

confidence: 98%

The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network

et al. 2016

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A majority of the research network sites participating in this survey use e-alerts for early notification of potential threats to hospitalized patients; however, there was significant variability in the nature of e-alerts between institutions. Use of one common electronic health record vendor at more than half of the participating sites suggests that it may be possible to standardize e-alerts across multiple sites in research networks, particularly among sites using the same medical record platform.

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Automated inhaled nitric oxide alerts for adult extracorporeal membrane oxygenation patient identification

Abstract: Diagnostic test, level V.

Cited by 4 publications

References 27 publications

Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series

Analysis of extracorporeal membrane oxygenation in trauma patients with acute respiratory distress syndrome: A case series

Extracorporeal life support in trauma: Indications and techniques

The Nature and Variability of Automated Practice Alerts Derived from Electronic Health Records in a U.S. Nationwide Critical Care Research Network

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