Abstract 367: Ventricular Assist Device Association in Improving Outcomes in Patients Resuscitated From Out of Hospital Cardiac Arrest
Bibliographic record
Abstract
Introduction: There has been continued debate and limited research on the efficacy of ventricular assist devices such as intra-aortic balloon pumps and Impella devices on improving survival outcomes in post cardiac arrest patients. Objective: The primary objective of this study is to assess whether the use of ventricular assist devices is associated with improved survival outcome in patients resuscitated from out-of-hospital cardiac arrest in Michigan. Methods: We matched cardiac arrest cases from 2014-2017 in the Michigan CARES Registry (CARES) and the Michigan Inpatient Database (MIDB) using probabilistic linkage. Ventricular assist devices (VAD) are defined as either Intra-aortic balloon pump (IABP) or Impella device identified using ICD-9 or 10 procedure codes. Multilevel, multivariable regression analyses were employed to evaluate the impact of device use on survival to hospital discharge, adjusting for variables normally predictive of cardiac arrest survival (age, location, witnessed, shockable rhythm). Results: A total of 3,790 CARES cases were matched with the MIDB of which 183 (4.8%) received IABP, 50 (1.3%) received impella devices, and 1,131 (29.8%) survived to hospital discharge. VAD use was associated with improved survival to discharge (OR=2.07, 95% CI 1.55, 2.77). IABP were used more frequently and associated with an improved outcome (OR=2.16, 95%CI 1.59, 2.93) compared to the Impella device (OR=1.72, 95% CI 0.96, 3.06). In a multivariable model, however, VAD use was no longer associated with an improved outcome (aOR =0.95, 95% CI 0.69, 1.31). In the subset of patients with a diagnosis of cardiogenic shock (n=725) we identified an improved survival to discharge with VAD use (OR= 1.84 95% CI 1.24, 2.73). IABP use was more frequent and associated with an improved outcome (OR=1.98, 95% CI 1.32, 2.98). After adjusting for patient characteristics, VAD use increased the odds of an improved outcome by 14% but was not statistically significant (aOR = 1.14, 95% CI 0.74, 1.77 ). Conclusion: Although limited by a low frequency of use, VAD or IABP alone was associated with improved outcome for post arrest care. However, in a multivariable analysis, VAD use was not associated with an independent improvement in post arrest survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".