Unmet Need
Extracorporeal membrane oxygenation (ECMO) is used to support ~6,200 critically ill patients annually [1, 2]. ECMO is used as a substitute heart and lungs when a patient’s own cannot adequately perform their normal functions; ECMO works by oxygenating and filtering carbon dioxide from a patient’s blood as it travels through a machine outside of the body. Patients who have failed traditional mechanical ventilation, are waiting for new organs, and/or have severe respiratory infection can be put on ECMO for varying periods of time as necessary. While patients are on ECMO, it is vital that they receive the proper amount of nutrition to support their individual needs.
The current gold standard to calculate energy expenditure (EE) is via indirect calorimetry (IC) based on the rate of oxygen consumption (VO2) and the rate of carbon dioxide production (VCO2) outputs taken in an indirect calorimeter operated by a trained technician[3]. While useful, IC is not a perfect system. The equation used was developed without taking all factors into account that impact an individual’s needs (i.e., body makeup, age). IC also requires a 24-hour urine sample, which does not allow for timely measurements. In addition, EE is calculated at discontinuous time points, which means that levels can change in the time between measurements without alerts to the respiratory technician. Therefore, there is a clear need to develop systems capable of continuous EE calculation in order to allow for real time adjustments based on patient nutritional needs.
Technology Overview
Researchers at Johns Hopkins have developed a system that allows for continuous, real time calculation of a patient’s EE while on ECMO. Using an oximeter and capnometer located in the inlet and outlet of the ECMO machine, VO2 and VCO2 readings are processed using code (licensed from SickBay) that generates waveforms corresponding to a patient’s EE, giving providers continuous measurements of a patient’s nutritional needs. This technology will improve care for patients who are experiencing acute respiratory failure, while saving hospitals time and money by automating a costly process previously performed by specially trained staff.
Stage of Development
Initial trials are underway to allow for optimization of capnometers, oximeters, and SickBay code.
Publication
N/A
