Program Code: SCF-DBI-PECMO-LIBERATION-0010**
Operational Window: Recovery Stabilization → Decannulation Readiness → Decannulation → Post-ECMO Recovery → Hospital Discharge → Long-Term Follow-Up
Primary Objective: Achieve safe liberation from ECMO while preserving organ recovery, neurologic integrity, endothelial resilience, immune competence, developmental potential, and long-term functional outcomes.
SECTION 10.1
CLINICAL POSITIONING
Traditional Decannulation Model
Focuses on:
Cardiac recovery
Pulmonary recovery
ECMO separation
Survival
SCF-DBI Liberation Model
Decannulation is viewed as:
Biological Independence Restoration
requiring recovery of:
Cardiovascular adaptation
Pulmonary adaptation
Neuroadaptive resilience
Endothelial recovery
Immune stability
Recovery intelligence
Core Principle
Successful decannulation occurs when native biology can reliably sustain adaptive function.
SECTION 10.2
ECMO LIBERATION INTELLIGENCE FRAMEWORK
Strategic Objective
Determine readiness for independent physiologic function.
Liberation Domains
Domain 1
Cardiac Independence
Domain 2
Pulmonary Independence
Domain 3
Neurologic Stability
Domain 4
Endothelial Stability
Domain 5
Immune Stability
Domain 6
Recovery Sustainability
Primary Output
ECMO Liberation Intelligence Score (ELIS)
SECTION 10.3
DECANNULATION READINESS ALGORITHM
Readiness Criteria
Stable oxygen delivery
Stable organ perfusion
Stable neurologic status
Positive recovery trajectory
Reduced support burden
Required Intelligence Scores
ANMS >70
NCRS >70
EII >70
STRI >70
CRIS >70
Readiness Classification
Green
Ready
ELIS >80
Yellow
Near Ready
ELIS 60–79
Orange
Recovery Required
ELIS 40–59
Red
Not Ready
ELIS <40
SECTION 10.4
CARDIAC LIBERATION ASSESSMENT
Strategic Objectives
Verify:
Native cardiac output
Ventricular reserve
Coronary perfusion adequacy
Recovery stability
Monitoring Variables
Echocardiography
Cardiac output
Lactate
NCRS
MRPS
Primary Output
Cardiac Liberation Score (CLS)
SECTION 10.5
PULMONARY LIBERATION ASSESSMENT
Strategic Objectives
Verify:
Gas exchange recovery
Pulmonary reserve
Ventilator independence potential
Monitoring Variables
Oxygenation
Ventilation
Compliance
PRI
ODIS
Primary Output
Pulmonary Liberation Score (PLS)
SECTION 10.6
RHENOVA DECANNULATION PRESERVATION BUNDLE
Objective
Prevent decannulation-associated adaptation failure.
Bundle Components
Component 1
Neuroprotection
Cerebral oxygenation optimization
CAI monitoring
Component 2
Hemodynamic Protection
Perfusion optimization
Lactate surveillance
Component 3
Endothelial Protection
EII stabilization
Glycocalyx preservation
Component 4
Recovery Preservation
CRIS optimization
Rehabilitation continuity
SECTION 10.7
DECANNULATION PROCEDURAL OPERATIONS
Pre-Decannulation Checklist
Liberation readiness confirmed
Hemostasis readiness confirmed
Recovery plan finalized
Rescue plan available
Family communication completed
Procedural Objectives
Safe circuit discontinuation
Vessel preservation
Hemostasis preservation
Recovery continuity
SECTION 10.8
IMMEDIATE POST-DECANNULATION SURVEILLANCE
First Hour
Monitor:
Perfusion
Oxygenation
Hemodynamics
Neurologic status
First Six Hours
Monitor:
Lactate clearance
NIRS
ANMS
NCRS
EII
First Twenty-Four Hours
Monitor:
Recovery progression
Organ recovery
Rehabilitation readiness
SECTION 10.9
POST-ECMO ORGAN RECOVERY PLATFORM
Organ Recovery Domains
Cardiac recovery
Pulmonary recovery
Neurologic recovery
Renal recovery
Hepatic recovery
Endothelial recovery
Primary Output
Organ Recovery Composite Index (ORCI)
SECTION 10.10
POST-ECMO ADAPTATION FAILURE SURVEILLANCE
Clinical Positioning
The highest-risk period occurs during:
First 72 hours after decannulation
Monitoring Domains
Recurrent shock
Respiratory deterioration
Neurologic decline
Endothelial dysfunction
Immune instability
Early Warning Indicators
ELIS decline >10%
ANMS decline >10%
EII decline >10%
CRIS decline >10%
SECTION 10.11
RHENOVA ECMO RECOVERY-TO-DISCHARGE PATHWAY
Phase I
Decannulation Stabilization
Objectives:
Physiologic independence
Organ stabilization
Phase II
Recovery Advancement
Objectives:
Mobility progression
Functional recovery
Phase III
Discharge Preparation
Objectives:
Family readiness
Rehabilitation planning
Long-term surveillance enrollment
SECTION 10.12
LONGITUDINAL ECMO SURVIVOR SURVEILLANCE PROGRAM
Monitoring Timeline
Decannulation
↓
ICU Discharge
↓
Hospital Discharge
↓
30 Days
↓
90 Days
↓
6 Months
↓
12 Months
↓
Annual Follow-Up
Surveillance Domains
Survival
Functional recovery
Neurodevelopment
Growth
Exercise capacity
Educational outcomes
Quality of life
SECTION 10.13
ECMO CENTER OUTCOME INTELLIGENCE SYSTEM
Strategic Objective
Track ECMO outcomes across the entire recovery continuum.
Outcome Domains
Clinical Outcomes
Survival
Organ recovery
Readmissions
Functional Outcomes
Independence
Mobility
Rehabilitation participation
Developmental Outcomes
Cognitive function
Educational performance
Psychosocial adaptation
SECTION 10.14
DECANNULATION ESCALATION MATRIX
Level 1
Enhanced Surveillance
Triggers:
Mild instability
Delayed recovery
Level 2
Focused Intervention
Triggers:
ELIS decline >10%
ORCI decline >10%
Level 3
Multidisciplinary Escalation
Triggers:
Organ recovery slowing
Functional regression
Level 4
Advanced Recovery Preservation Activation
Triggers:
ANMS <60
Progressive deterioration
Level 5
Recannulation Rescue Assessment
Triggers:
ANMS <40
Severe adaptation failure
Refractory physiologic collapse
SECTION 10.15
LIBERATION SUCCESS ENDPOINTS
Clinical
Successful decannulation
No recannulation
Stable organ recovery
Reduced complications
Recovery
Accelerated rehabilitation
Improved discharge readiness
Improved family preparedness
Biological Intelligence
ELIS >80
ANMS >80
NCRS >80
EII >80
STRI >80
CRIS >80
ORCI >80
Sustained physiologic independence
PAGE 10 COMPLETION
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