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Review
. 2023 May;38(1_suppl):68-81.
doi: 10.1177/02676591231163688. Epub 2023 Apr 20.

Clinical decision support for ExtraCorporeal Membrane Oxygenation: Will we fly by wire?

Lara Pladet  1 , Kim Luijken  2 , Libera Fresiello  3 , Dinis Dos Reis Miranda  4 , Jeannine A Hermens  1 , Maarten van Smeden  2 , Olaf Cremer  1 , Dirk W Donker  1   3 , Christiaan L Meuwese  4   5
Affiliations
Review

Clinical decision support for ExtraCorporeal Membrane Oxygenation: Will we fly by wire?

Lara Pladet et al. Perfusion. 2023 May.

Abstract

Prognostic modelling techniques have rapidly evolved over the past decade and may greatly benefit patients supported with ExtraCorporeal Membrane Oxygenation (ECMO). Epidemiological and computational physiological approaches aim to provide more accurate predictive assessments of ECMO-related risks and benefits. Implementation of these approaches may produce predictive tools that can improve complex clinical decisions surrounding ECMO allocation and management. This Review describes current applications of prognostic models and elaborates on upcoming directions for their clinical applicability in decision support tools directed at improved allocation and management of ECMO patients. The discussion of these new developments in the field will culminate in a futuristic perspective leaving ourselves and the readers wondering whether we may "fly ECMO by wire" someday.

Keywords: ECLS; Extracorporeal membrane oxygenation; digital twin; epidemiological- and computational modeling; extracorporeal life support; fly by wire systems; prognostic models.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: D.W. Donker from the institutional research cooperation of the Cardiovascular and Respiratory physiology group of the University of Twente with Maquet Critical Care AB, Solna, Sweden and Sonion Nederland BV, Hoofddorp, The Netherlands (no personal honoraria received). C. Meuwese received research funding from “Stichting Gezondheidszorg Spaarneland (SGS)” Fund and The Dutch Heart Foundation (Hartstichting). D. dos Reis Miranda has received honoraria for scientific presentations from Maquet Getinge and Xenios. For the remaining authors none were declared.

Figures

Figure 1.
Figure 1.
A digital twin in a healthcare environment.
Figure 2.
Figure 2.
Simplified example of a flight control system.
Figure 3.
Figure 3.
A hypothetical patient control system for an intensive care patient supported with ECMO.
Figure 4.
Figure 4.
Overcorrection of noradrenaline dosages resulting in undesired fluctuations in mean arterial blood pressure.
See this image and copyright information in PMC

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