History of extracorporeal membrane oxygenation (ECMO) for hypoxemic respiratory failure NeonatesECMO has been used for more than 50 years as salvage therapy for patients with severe cardiopulmonary failure that is refractory to conventional treatment. In the late 1930s, John Gibbon (1), after witnessing a young patient's death from a pulmonary embolism, began experimenting with extracorporeal blood-flow circuits that might temporarily support cardiorespiratory function. He hypothesized that an effective circuit might allow surgical thrombectomy of massive life-threatening emboli and even potentially allow surgery on the heart. After two decades of painstaking experimentation, Gibbon performed the first successful operation using such an extracorporeal

Introduction: This study sought to evaluate the impact of changes made to the process of continually screening hospitalized patients for decompensation. Methods: Patients admitted to hospital wards were screened using a cloud-based early warning score (modified National Early Warning Score [mNEWS]). Patient with mNEWS ≥7 triggered a structured response. Outcomes of this quality improvement study during the intervention period from February through August 2018 (1741 patients) were compared with a control population (1,610 patients) during the same months of 2017. Results: The intervention group improved the time to the first lactate order within 24 hours of mNEWS ≥7 (p < .001), the primary outcome, compared with the control group. There was no significant improvement in time to intensive care unit (ICU) transfer, ICU length of stay (LOS), or hospital mortality. Among patients with a lactate ordered within 24 hours, there was a 47% reduction of in-hospital mortality (odds ratio 0.53, 95% confidence interval 0.3–0.89, p = .02) and a 4.7 day reduction in hospital LOS (p < .001) for intervention versus control cohorts. Conclusions: Cloud-based electronic surveillance can result in earlier detection of clinical decompensation. This intervention resulted in lower hospital LOS and mortality among patients with early detection of and intervention for clinical decompensation.

No abstract

Background: Accurate documentation of in-hospital cardiac arrest is essential to patient care. Recently, the American Heart Association created Get with the Guidelines-Resuscitation (GWTG-R) to facilitate the capture, analysis, and reporting of cardiac arrest data. GWTG-R criteria include witnessed events, confirmation of airway, two minute time-to-shock for ventricular tachycardia or fibrillation, and five minute time-to-first dose of epinephrine for pulseless electrical activity. The goal of our study was to increase adherence to GWTG-R measures by improving the quality of documentation of cardiac arrests by resident code leaders through the development and implementation of a standardized code note template. Methods: A retrospective chart review was performed on resident-authored code notes before and after implementation of a standardized code note. An electronic medical record template was developed which highlighted GWTG-R metrics. This note was made available to all resident physician code leaders. Reviewed notes were assessed for documentation of GWTG-R metrics and clinical reasoning. Results: Twenty-two notes were reviewed prior to and seventeen notes after implementation of a standardized code note template. 14/17 (82%) of post-implementation notes used the standardized template. All GWTG-R categories and clinical reasoning documentation trended toward improvement. Documentation of time-to-epinephrine significantly increased from 5.9% to 91.7% (Figure 1). Conclusions: Development of a standardized code note template improved documentation of GWTG-R quality measures for in-hospital cardiac arrest. Hospital compliance with guidelines improved following this intervention, qualifying for GWTG-R Bronze for three consecutive months of compliance. Expansion of the standardized code note for widespread use by providers throughout the hospital is expected to continue to improve code documentation and hospital compliance with GWTG-R.