Abstract 14041: The Association of Left Heart Pressures and Survival After Starting Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
Bibliographic record
Abstract
Introduction: Despite the ability to provide full hemodynamic support in patients with refractory cardiogenic shock (CS), a potential limitation is elevated intracardiac filling pressures from increased left ventricular afterload. There is a paucity of data regarding the correlation of left atrial pressures (LAP) with outcomes. Hypothesis: Our objective was to determine association between LAP and survival for patients with refractory CS after 24 hours of VA ECMO support. Methods: Cohort analysis among 10,906 patients ≥18yrs from the Extracorporeal Life Support Organization (ELSO) Registry (2015 - 2020), with refractory CS on VA ECMO. LAP values were defined as pulmonary capillary wedge pressure (PCWP) or pulmonary arterial diastolic pressure (PAD) values if PCWP was missing. The exposure was LAP values at 24 hours on VA ECMO support. Our primary outcome was survival to discharge. We used multivariate regression, adjusted for age, and the following pre-ECMO variables: PaO2/FiO2, pH, mean arterial blood pressure (MAP), and SCAI classification; and the following variables after 24 hours of support: pH, MAP; and year. Results: Median age was 57 [IQR,46; 65] years old and 31% were 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 hemodynamic monitoring was measured in 33% (n=3608) of patients. Median LAP was 18mmHg [IQR,14; 23]. Every 1 mm Hg incremental of LAP on support was associated with lower survival (aOR 0.97 [95% CI 0.95 to 0.98]; p<0.001), and 30% increase in duration of VA-ECMO support (beta-coeff 1.37 [95% CI 0.42 to 2.3]; p=0.005). Conclusions: Reduced LAP may be associated with higher adjusted hospital survival in patients with refractory CS on VA-ECMO. These findings merit further investigation and prospective validation to assess the relationship between hemodynamically tailored management 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) | 0.004 | 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".