Transportable extracorporeal lung support for rescue of severe respiratory failure in combat casualties

Abstract

Therapeutic/care management study, level V.

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

“…Electronic alerts may also be useful for early activation of transport teams based in adult and pediatric ECMO centers within a regional civilian health system 33 or who are involved with long-range military transport. 23 In some civilian centers and the austere environment of combat, iNO is not available; however, nebulized prostacyclin has been described as an alternative, in which case the electronic sniffer could be modified to search for this parameter in the EMR instead. 23,34 Future work in the use of electronic alerts for these highrisk patients should formally evaluate the time from alert to ECMO evaluation, time from alert to ECMO initiation, interventions recommended by or performed by the ECMO team, Figure 2.…”

“…23 In some civilian centers and the austere environment of combat, iNO is not available; however, nebulized prostacyclin has been described as an alternative, in which case the electronic sniffer could be modified to search for this parameter in the EMR instead. 23,34 Future work in the use of electronic alerts for these highrisk patients should formally evaluate the time from alert to ECMO evaluation, time from alert to ECMO initiation, interventions recommended by or performed by the ECMO team, Figure 2. Evolution of gas exchange characteristics in terms of PFR (A) and age-adjusted OI (B) from iNO alert (iNO) to immediately pre-ECMO (Pre) to 24 hours after ECMO initiation (24 Hr) and immediately before ECMO decannulation (End).…”

“…11,22 This principle has even been applied in combat casualties with severe respiratory failure in Iraq and Afghanistan to good effect. 23,24 Ultimately, to maximize the benefit of ECMO, candidate patients must be identified expeditiously.…”

“…25Y27 We recently established an adult ECMO program at the San Antonio Military Medical Center (SAMMC) designed to support both our in-house patient population and those beneficiaries across the Department of Defense with severe respiratory failure including combat casualties. 23 We hypothesized that our Smart Alert system could be used to identify candidate ECMO patients with severe respiratory failure in our hospital. To more specifically identify patients who had failed initial ARDS interventions, we chose inhaled nitric oxide (iNO) initiation as the trigger for sending an electronic alert to the ECMO team since iNO therapy is typically used as a rescue oxygenation therapy for ARDS patients in our hospital.…”

Coming to terms with tissue engineering and regenerative medicine in the lung

“…Furthermore, the need for pump-based devices and associated equipment to maintain flow will likely limit miniaturization. In this regard, pumpless technologies with lowresistance diffusion membranes such as the Novalung interventional lung assist device (Novalung, Heilbronn, Germany) are now being explored for use in intensive care settings for removal of CO 2 in patients experiencing trauma, infection, and acute respiratory disease syndrome or even as a bridge to lung transplantation (13,15,26,46,51). However, even though these emerging approaches hold substantial potential for bridging toward transplantation, unlike the increasingly popular ventricular-assist devices that are emerging therapies for treating heart failure, transportable lung-assist devices are still in the research phase (74 -76, 188).…”