Inadequate oxygen delivery index dose is associated with cardiac arrest risk in neonates following cardiopulmonary bypass surgery

Futterman, Craig; Salvin, Joshua W.; McManus, Michael L.; Lowry, Adam W.; Baronov, Dimitar; Almodovar, Melvin C.; Pineda, José; Nadkarni, Vinay; Laussen, Peter C.; Gazit, Avihu Z.

doi:10.1016/j.resuscitation.2019.07.013

Cited by 36 publications

(32 citation statements)

References 21 publications

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“…[9][10][11] Data fed into existing models are often invasively obtained or inherently flawed (ie, traditional vital signs), [9][10][11] which may contribute to known issues with missingness and low positive predictive values. 8 Only one algorithm to date (IDO 2 index, Etiometry, Inc) integrates with a visualization platform in near real time at the bedside, 11 which is a prerequisite to making timely inferences and decisions about critically ill patients. 27 These barriers have precluded the use of prediction algorithms at the bedside for critically ill patients with CHD, who are at highest risk for hemodynamic decompensation compared to other types of critically ill patients.…”

Section: Commentmentioning

confidence: 99%

“…Models published to date rely on a relatively sophisticated informatics infrastructure to collate, clean, and process physiologic data not accessible to all hospitals. [9][10][11] Data fed into existing models are often invasively obtained or inherently flawed (ie, traditional vital signs), [9][10][11] which may contribute to known issues with missingness and low positive predictive values. 8 Only one algorithm to date (IDO 2 index, Etiometry, Inc) integrates with a visualization platform in near real time at the bedside, 11 which is a prerequisite to making timely inferences and decisions about critically ill patients.…”

Section: Commentmentioning

confidence: 99%

“…8 Predictive algorithms based on physiologic data have been developed for critically ill children designed to herald clinical decompensation 9,10 or inadequate oxygen delivery (IDO 2 index, Etiometry, Inc). 11 The Compensatory Reserve Index (CRI) is a noninvasive Food and Drug Administration (FDA)–cleared monitoring technology that predicts hemodynamic decompensation from hemorrhagic shock in adults using machine learning (ML). 12,13 The development and validation of the CRI have been previously described.…”

Section: Introductionmentioning

confidence: 99%

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Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Ehrmann

Leopold

Campbell

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Early warning systems that utilize dense physiologic data and machine learning may aid prediction of decompensation after congenital heart surgery (CHS). The Compensatory Reserve Index (CRI) analyzes changing features of the pulse waveform to predict hemodynamic decompensation in adults, but it has never been studied after CHS. This study sought to understand the feasibility, safety, and potential utility of CRI monitoring after CHS with cardiopulmonary bypass (CPB). Methods: A single-center prospective pilot cohort of patients undergoing pulmonary valve replacement was studied. Compensatory Reserve Index was continuously measured from preoperative baseline through the first 24 postoperative hours. Average CRI values during selected procedural phases were compared between patients with an intensive care unit (ICU) length of stay (LOS) <3 days versus LOS ≥3 days. Results: Twenty-three patients were enrolled. On average, 17,445 (±3,152) CRI data points were collected and 0.33% (±0.40) of data were missing per patient. There were no adverse events related to monitoring. Five (21.7%) patients had an ICU LOS ≥3 days. Compared to the ICU LOS <3 days group, the ICU LOS ≥3 days group had a greater decrease in CRI from baseline to immediately after CPB (−0.3 ± 0.1 vs −0.1 ± 0.2, P = .003) and were less likely to recover to baseline CRI during the monitoring period (20% vs 83%, P = .017). Conclusions: Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Ehrmann

Leopold

Campbell

et al. 2021

World J Pediatr Congenit Heart Surg

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“…One of these risk models, the U.S. Food and Drug Administration (FDA) 510(k) cleared inadequate delivery of oxygen index (ID o 2 ) algorithm (Etiometry, Boston MA), uses available physiologic and laboratory variables to compute in near real-time the probability of the mixed venous oxygen saturation (Sv o 2 ) lower than 40%. Elevated ID o 2 is associated with increased risk of cardiac arrest in neonates following surgical repair of CHD ( 9 ).…”

mentioning

confidence: 99%

Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery

Goldsmith

Futterman

Gazit

et al. 2021

Critical Care Explorations

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Advanced clinical decision support tools, such as real-time risk analytic algorithms, show promise in assisting clinicians in making more efficient and precise decisions. These algorithms, which calculate the likelihood of a given underlying physiology or future event, have predominantly been used to identify the risk of impending clinical decompensation. There may be broader clinical applications of these models. Using the inadequate delivery of oxygen index, a U.S. Food and Drug Administration-approved risk analytic algorithm predicting the likelihood of low cardiac output state, the primary objective was to evaluate the association of inadequate delivery of oxygen index with success or failure of weaning vasoactive support in postoperative cardiac surgery patients. DESIGN:Multicenter retrospective cohort study. SETTING: Three pediatric cardiac ICUs at tertiary academic children's hospitals. PATIENTS:Infants and children greater than 2 kg and less than 12 years following cardiac surgery, who required vasoactive infusions for greater than 6 hours in the postoperative period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Postoperative patients were identified who successfully weaned off initial vasoactive infusions (n = 2,645) versus those who failed vasoactive wean (required reinitiation of vasoactive, required mechanical circulatory support, renal replacement therapy, suffered cardiac arrest, or died) (n = 516). Inadequate delivery of oxygen index for final 6 hours of vasoactive wean was captured. Inadequate delivery of oxygen index was significantly elevated in patients with failed versus successful weans (inadequate delivery of oxygen index 11.6 [sd 19.0] vs 6.4 [sd 12.6]; p < 0.001). Mean 6-hour inadequate delivery of oxygen index greater than 50 had strongest association with failed vasoactive wean (adjusted odds ratio, 4.0; 95% CI, 2.5-6.6). In patients who failed wean, reinitiation of vasoactive support was associated with concomitant fall in inadequate delivery of oxygen index (11.1 [sd 18] vs 8.9 [sd 16]; p = 0.007). CONCLUSIONS:During the de-escalation phase of postoperative cardiac ICU management, elevation of the real-time risk analytic model, inadequate delivery of oxygen index, was associated with failure to wean off vasoactive infusions. Future studies should prospectively evaluate utility of risk analytic models as clinical decision support tools in de-escalation practices in critically ill patients.KEY WORDS: clinical decision support systems; critical illness; low cardiac output; pediatric intensive care unit; physiologic monitoring; risk assessment C ritically ill pediatric patients with congenital and acquired cardiovascular disease have high rates of inhospital cardiac arrest and death (1). Clinical decision support tools aimed at identifying cardiac patients at high risk of clinical deterioration (2-6) have been described in the literature,

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“…In conclusion, the findings from their study make intuitive sense and corroborate the observation that many investigators in surgery and critical care have reported about oxygen delivery and consumption dynamics in patients. 2 , 3 , 4 Should these findings be validated in a contemporaneous prospective or even randomized studies, it should lead to a justification for more widespread use of more contemporary sophisticated monitoring, which might, in turn, lead to improved patient outcomes.…”

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confidence: 99%

Commentary: Taking the next step in cardiopulmonary bypass management

Lodge

Siffring

2020

JTCVS Techniques

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Inadequate oxygen delivery index dose is associated with cardiac arrest risk in neonates following cardiopulmonary bypass surgery

Cited by 36 publications

References 21 publications

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Use of a Risk Analytic Algorithm to Inform Weaning From Vasoactive Medication in Patients Following Pediatric Cardiac Surgery

Commentary: Taking the next step in cardiopulmonary bypass management

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