Postcardiotomy extracorporeal membrane oxygenation for infective endocarditis in a patient with intravenous drug use and COVID-19 infection: An ethical dilemma
Bibliographic record
Abstract
In this report, we present a case of native valve infective endocarditis due to active intravenous drug use in a 29-yearold female patient that presented during the peak of the coronavirus disease 2019 (COVID-19) pandemic. The patient underwent a complex cardiac surgical intervention with aortic valve replacement and mitral valve repair. Postcardiotomy extracorporeal membrane oxygenation (ECMO) support was required due to severe biventricular dysfunction. In this unprecedented situation, multiple ethical dilemmas arose at different stages in the management of this patient. These dilemmas stemmed from the lack of evidence supporting the use of postcardiotomy ECMO in patients with active intravenous drug use and the scarcity of resources due to the COVID-19 pandemic, resulting in pressure put on our healthcare system. In this case report, we present the decisions made by our team, taking into account both the patient"s best interests and the available resources. We hope this decision-making process will serve as a valuable learning experience for other teams and will act as an antecedent for similar situations in the future.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.004 |
| Insufficient payload (model declined to judge) | 0.001 | 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".