Automated Inhaled Nitric Oxide Alerts for Adult Extracorporeal Membrane Oxygenation Patient Identification
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Recently, automated alerts have been used to identify patients with respiratory failure based on set criteria, which can be gleaned from the electronic medical record EMR. Such an approach may also be useful for identifying patients with severe adult respiratory distress syndrome ARDS who may benefit from extracorporeal membrane oxygenation ECMO. Inhaled nitric oxide iNO is a common rescue therapy for severe ARDS which can be easily tracked in the EMR, and some patients started on iNO may have indications for initiating ECMO. This case series summarizes our experience with using automated electronic alerts for ECMO team activation focused particularly on an alert triggered by the initiation of iNO. METHODS After a brief trial evaluation, our Smart Alert system generated an automated page and e-mail alert to ECMO team members whenever a nonzero value for iNO appeared in the respiratory care section of our EMR. If iNO was initiated for severe respiratory failure, a detailed evaluation by the ECMO team determined if ECMO was indicated. For those patients managed with ECMO, we tabulated baseline characteristics, indication for ECMO, and outcomes. RESULTS From September 2012 to July 2013, 45 iNO alerts were generated on 42 unique patients. Six patients 14 met criteria for ECMO. Of these, four were identified exclusively by the iNO alert. At the time of the alert, the median PaO2-to-FIO2 ratiowas 64 mm Hg range, 55-107 mm Hg, the median age-adjusted oxygenation index was 73 range, 51-96, and the median Murray score was 3.4 range, 3-3.75, indicating severe respiratory failure. Median time from iNO alert to ECMO initiation was 81 hours range, -2 to 292 hours. Survival to hospital discharge was 83 in those managed with ECMO. CONCLUSION Automated alerts may be useful for identifying patients with severe ARDS who may be ECMO candidates.
- Medicine and Medical Research