Abstract 12994: Invasive Left Atrial Pressure Monitoring and Survival on Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
Bibliographic record
Abstract
Introduction: Elevated left atrial pressures (LAP) are associated with worse outcomes among patients with cardiogenic shock (CS), yet there are limited data on the utility of continuous invasive monitoring of LAPs on outcomes for CS. This is additionally true among refractory CS patients on peripheral VA ECMO, which itself can increase arterial afterload. Hypothesis: Our objective was to determine whether invasive LAP monitoring impacts survival for patients with refractory CS after 24 hours of VA ECMO support. Methods: We performed a cohort analysis among 10,906 patients ≥18yrs of age from the Extracorporeal Life Support Organization (ELSO) Registry from 2015 - 2020, with refractory CS treated with VA ECMO. The presence of invasive LAP monitoring was defined as either pulmonary capillary wedge pressure (PCWP) or pulmonary arterial diastolic pressure (PAD) values at 24 hours on VA ECMO. The exposure was measurement of LAPs at 24 hours on VA ECMO support, and the primary outcome was 30 day survival. We performed Kaplan Meier survival analysis, adjusting for age, PaO2/FiO2, pH, SCAI classification stage prior to ECMO, presence of a pre-ECMO cardiac arrest, mean arterial blood pressure on ECMO and year. Results: Median age of patients was 57 [IQR,46; 65] years with 31% females. Thirty two percent (n=3,465) presented with acute myocardial infarction, 29% (n=3,112) with acute heart failure and 1% (n=965) with both etiologies. Invasive LAP monitoring at 24 hours was performed in 33% (n=3608) of patients. The use of invasive LAP was associated with lower mortality (adjusted Hazard Ratio 0.88 [95% CI 0.81 to 0.95]; p=0.002). Conclusions: Implementation of invasive LAP monitoring may be associated with higher adjusted hospital survival in patients with refractory CS requiring VA-ECMO support. These findings merit further investigation and prospective validation to assess the relationship between invasive hemodynamic monitoring and outcomes in this patient population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 |
| 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 | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".