Boston Children’s Hospital Multi-center Study Finds Etiometry’s Risk Analytics Algorithms May Help Assess Extubation Failure Following Congenital Cardiac Surgery

Results published in Pediatric Critical Care Medicine demonstrate that the IDO2 and IVCO2 Indices may support more informed ventilator liberation decisions

May 19, 2025 – BOSTON – A newly published multi-center study has found that Etiometry’s FDA-cleared physiologic risk analytics—IDO2 and IVCO2—were found to be associated with increased risk of extubation failure in retrospective analysis, supporting clinician risk stratification. The retrospective cohort study, led by Dr. Daniel Hames of Boston Children’s Hospital and colleagues and featured in Pediatric Critical Care Medicine, analyzed 736 neonates across eight international pediatric cardiac intensive care units (ICUs). The research found that elevated IDO2 and IVCO2 values in the hours before extubation were associated with a significant increase in odds of EF.

The IDO2 and IVCO2 indices, delivered via the Etiometry Platform, provide near real-time, continuous assessment of a patient’s risk for inadequate oxygen delivery or ventilation. These metrics are FDA-cleared for use in patients from birth through 12 years of age and are designed to support more informed clinical decision-making in intensive care.

Extubation failure—defined as the need for reintubation within 48 hours—has demonstrated association with increased odds of cardiac arrest, longer ICU stays, and mortality. It also contributes to prolonged mechanical ventilation, which has been widely linked in previous studies to ventilator-associated complications such as pneumonia, increased sedative exposure, and other hospital-acquired conditions.

The study demonstrates that incorporating continuous physiologic monitoring and risk analytics alongside traditional clinical assessment may improve clinicians’ ability to
identify high-risk patients and time extubation more precisely.

“The novelty of this work is that it lays the foundation for hospitals to harness high-fidelity data sets to better understand how vital signs, care practices, decision-making, and outcomes are interrelated,” said Dr. Daniel Hames of the Division of Cardiovascular Critical Care at Boston Children’s Hospital and Assistant Professor of Pediatrics at Harvard Medical School. “It’s a step toward enabling ICUs to continuously and automatically evaluate their clinical practices—like extubation protocols—and refine them based on real-world data to ultimately improve care.”

Study highlights include:
● The study incorporated high-fidelity data merged from 8 participating centers.
● 13.9% of neonates experienced extubation failure.
● Neonates with single ventricle anatomy and those requiring preoperative respiratory support had significantly greater odds of EF.
● Elevated DO2 (≥25) or IVCO2 (≥50) in the two hours prior to extubation were independently associated with increased odds of EF (OR 1.77 [95% CI, 1.01–3.12]).
● Adding IDO2/IVCO2 to clinical models improved predictive performance, with a Net Reclassification Index (NRI) of 45%.
● Kaplan-Meier analysis showed that neonates with lower IDO2 and IVCO2 had significantly higher likelihood of remaining successfully extubated.

 Study Access:
“Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multi-center Retrospective Cohort, 2017–2020”
Published in Pediatric Critical Care Medicine (DOI:10.1097/PCC.0000000000003703)
Lead Author: Daniel L. Hames, MD, Boston Children’s Hospital and Harvard Medical School

Disclosure Statement:
The Etiometry platform, which includes the risk analytics used in the study, incorporates as a component the “T3 software” developed at Boston Children’s Hospital.  BCH retains ownership in the T3 software, and has licensed it to Etiometry. As part of the license agreement, royalties are paid to Boston Children’s Hospital. As a result, Boston Children’s Hospital may benefit financially.

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About Etiometry

Founded in 2010, Etiometry is a leader in clinical decision-support software designed to help clinicians in intensive care units make data-driven, proactive decisions. By leveraging advanced analytics and AI-powered insights, the company empowers care teams to detect subtle changes in patient conditions, prevent complications, and improve recovery times. Etiometry has received ten FDA clearances and is trusted by leading healthcare institutions worldwide, including top-ranked academic medical centers and pediatric hospitals. The company is committed to advancing patient safety, improving clinical efficiency, and lowering the cost of care through smarter data utilization.

To learn more, visit www.etiometry.com.

Media Contact:
Hyedi Nelson
Bellmont Partners
Hyedi@bellmontpartners.com
651-757-7054