Association of Standardized Liberation Trials and Duration of Venovenous Extracorporeal Membrane Oxygenation in Patients with Acute Respiratory Failure
Bibliographic record
Abstract
Abstract Rationale There is a paucity of evidence around strategies to liberate patients from venovenous (VV) extracorporeal membrane oxygenation (ECMO) for acute respiratory failure. Objectives The primary aim of this study was to determine if adopting standardized liberation trials (SLTs) for VV ECMO is associated with the duration of ECMO. The secondary aim was to identify factors associated with unsafe liberation and the effects of unsafe liberation on mortality to intensive care unit (ICU) discharge. Methods This was a single-center retrospective cohort study of patients on VV ECMO for severe respiratory failure comparing endpoints between intervention (SLT) and control (no SLT) periods. Results A total of 262 patients were included in the study, 13% (35 of 262) received SLTs, and 150 patients were decannulated from ECMO. Implementing SLTs was strongly associated with the duration of VV ECMO to first successful liberation trial (hazard ratio [HR], 1.88 [95% confidence interval (CI), 1.16 to 3.06]; P = 0.01) and decannulation (HR, 1.92 [95% CI, 1.0 to 3.06]; P = 0.01) without increasing the frequency of unsafe liberation (21% [5 of 23] with SLTs vs. 19% [24 of 127] without SLTs; odds ratio [OR], 1.19 [95% CI, −0.4 to 3.5]; P = 0.7). Unsafe liberation was strongly associated with ICU mortality (HR, 4.15 [95% CI, 1.24 to 13.9]; P = 0.02). Factors associated with unsafe liberation were respiratory rate (OR, 1.49 per 5 breaths/min increase [95% CI, 1.07 to 2.08]; P = 0.02) and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (OR, 0.73 per 30 mm Hg increase [95% CI, 0.57 to 0.93]; P = 0.01) immediately before decannulation. Conclusions Incorporating SLTs was significantly associated with the duration of VV ECMO, without increasing the frequency of unsafe liberation. Unsafe liberation was associated with increased ICU mortality.
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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 | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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".