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

Slava M. Belenkiy, Andriy I. Batchinsky, Timothy S. Park, David E. Luellen, Maria L. Serio-Melvin, Leopoldo C. Cancio, Jeremy C. Pamplin, Kevin K. Chung, Josè Salinas, Jeremy W. Cannon*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


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 ratio was 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, -2-292 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. LEVEL OF EVIDENCE: Diagnostic test, level V.

Original languageEnglish
Pages (from-to)S184-S189
JournalJournal of Trauma and Acute Care Surgery
Issue number3 SUPPL. 2
StatePublished - 2014
Externally publishedYes


  • Adult respiratory distress syndrome
  • automated alert
  • extracorporeal membrane oxygenation
  • inhaled nitric oxide


Dive into the research topics of 'Automated inhaled nitric oxide alerts for adult extracorporeal membrane oxygenation patient identification'. Together they form a unique fingerprint.

Cite this