P-204ROLE OF EXTRACORPOREAL LIFE SUPPORT AFTER PULMONARY ENDARTERECTOMY: A SINGLE CENTRE EXPERIENCE
Bibliographic record
Abstract
Objectives: Extracorporeal Life Support (ECLS) for rescue after pulmonary endarterectomy (PEA) has become a viable option. This study aims to present a single centre experience looking at the indications, risk factors and outcome of ECLS after PEA. Methods: Retrospective analysis of all patients undergoing PEA from Jan 2008 to Dec 2014 in our institution. Results: Among 144 consecutive patients undergoing PEA for chronic thromboembolic pulmonary hypertension, 6 (4%) received ECLS postoperatively for right ventricular (RV) failure (n = 3), severe hypoxemia (n = 2), and hemorrhagic pulmonary edema (n = 1). ECLS configuration was central veno-arterial (cVA) in 3 patients, peripheral VA (pVA) in 1 and veno-venous (VV) in 2. One patient with cVA was switched to VV after 5 days. Overall ECLS duration ranged between 3 and 39 (median 5) days. ECLS patients had higher preoperative total pulmonary vascular resistance (TPR) compared to non-ECLS patients (1477 ± 671 Dynes.s.cm−5 vs 954 ± 462 Dynes.s.cm−5, P = 0.009) and more frequently required hospital admission for RV failure before surgery (50% vs 9%, P = 0.02). All patients requiring VA ECLS had a preoperative TPR >1200 Dynes.s.cm−5. Non-significant differences were found for preoperative 6' walk distance (341 ± 193 m vs 375 ± 132 m, P = 0.5) and brain natriuretic peptide (391 ± 611 pg/ml vs 277 ± 367 pg/ml, P = 0.5). The overall in-hospital mortality rate for all patients was 2% (3/144), including the ECLS patient on pVA. The remaining 5 ECLS patients (83%) were discharged from hospital and are alive after a median follow-up of 7 (range 2-23) months. Two ECLS patients (40%) are on therapy for residual PH compared to 13 (10%) in the non-ECLS patients (P = 0.09). Conclusions: ECLS is a safe and important rescue option after PEA. cVA configuration is theoretically favoured in that it temporarily decreases the total flow through the damaged post-endarterectomy pulmonary vasculature. The use of ECLS may expand eligibility for PEA by allowing sicker patients to undergo surgery with good results. Disclosure: No significant relationships.
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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) | 0.001 | 0.001 |
| 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".