Veno-Venous Extracorporeal Membrane Oxygenation for Fat Embolism
Bibliographic record
Abstract
Pulmonary fat embolism is an infrequent but a serious complication of major trauma. Patients can suffer severe respiratory failure with sudden and unexpected onset, which can happen within 24 hours of trauma. The spectrum of presentations can vary from mild shortness of breath to sudden death. When respiratory failure ensues the clinical and radiological presentation resembles acute respiratory distress syndrome (ARDS). There is no evidence-based specific treatment for the condition, and conventional respiratory support often leads to recovery. In extreme cases the resulting hypoxemia and hypercarbia can be fatal. In other ARDS cases temporary support with extracorporeal membrane oxygenation (ECMO) can offer 65% survival (ELSO registry data). However, in cases of fat embolism the fat load can be transferred to the oxygenator and impact its function, and there is a scarcity of published data, leading to a relative reluctance to provide such support. We present a case of a 32-year-old patient following from traumatic bilateral below knee amputations. He suffered from pulmonary fat embolism leading to ARDS, which could not be adequately supported by conventional mechanical ventilation of the lungs. We considered the disadvantages of oxygenator malfunction due to fat loading, as well as the need for early oxygenator replacement. However, on the grounds of good prognosis for recovery, and potential for a short term ECMO support, the decision was made to commence veno-venous ECMO. Support on VV ECMO for total of 6 days allowed successful respiratory recovery and subsequent discharge home with ongoing rehabilitation. J Med Cases. 2014;5(9):488-490 doi: http://dx.doi.org/10.14740/jmc1877e
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".