Bibliographic record
Abstract
Central MessageECMO is an important bridge from ventilatory failure to normal lung function and can provide precious time for tracheal injury.See Article page 389. ECMO is an important bridge from ventilatory failure to normal lung function and can provide precious time for tracheal injury. See Article page 389. In this issue of JTCVS Techniques, Hawkins and colleagues1Hawkins R.B. Thiele E.L. Huffmyer J. Bechtel A. Yount K.W. Martin L.W. Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tear.J Thorac Cardiovasc Surg Tech. 2020; 4: 389-391Scopus (1) Google Scholar present a challenging case of iatrogenic tracheal injury after multiple intubation attempts. The patient had presented with respiratory compromise due to viral pneumonia, and the resultant loss of tidal volume due to the tracheal injury precipitated profound respiratory failure and acidosis. After transfer to the authors' institution, the patient was promptly placed on veno-venous extracorporeal membrane oxygenation (ECMO), which allowed for stabilization and normalization of acid-base status. At 12 hours after ECMO, the trachea was successfully repaired, and the patient was eventually able to transition back to normal health. This case report is not the first to describe ECMO as a bridge for surgery. It has been described in patients with trauma, lung transplantation, and tracheal injury. However, this case report is unique inasmuch as ECMO was not the only bridge. The rapid transfer to a tertiary center was probably a key—and perhaps underrecognized—step in saving this patient's life. Delays in transfer could have resulted in irreversible lung and brain damage that might not have been salvageable. The decision to delay surgical repair after the patient was placed on ECMO was also a key element in this success story. The aggressive treatment of complications, necessitating repeat surgery, is another important link in the chain. As such, although ECMO provided a bridge to surgical repair, this bridge had multiple pillars. This case demonstrates yet again that surgery is a multiteam sport, not a one-team sport. As we push the boundaries of what we can achieve in medicine, we find ourselves being operatives within a complex and interconnected system of disciplines and decisions, and building bridges becomes the best strategy for success. Extracorporeal membrane oxygenation for management of iatrogenic distal tracheal tearJTCVS TechniquesVol. 4PreviewTracheobronchial injuries during intubation are rare, with an incidence of 0.005%; thus, diagnosis requires a high index of suspicion.1 Risk factors include female sex, age older than 65 years, and emergency intubation.1,2 Temporal correlation with respiratory failure, subcutaneous emphysema, and pneumothorax/pneumomediastinum should prompt evaluation of the tracheobronchial tree. Bronchoscopy is instrumental for diagnosis and management, including placement of the endotracheal tube distal to the injury before definitive intervention. Full-Text PDF Open Access
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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 | 0.002 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.003 | 0.007 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.043 | 0.043 |
| Insufficient payload (model declined to judge) | 0.015 | 0.011 |
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".