A simple VA-ECMO bundle in adult patients with cardiogenic shock: an analysis of ELSO registry
Bibliographic record
Abstract
Background The optimal management strategy for patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) remains uncertain. To evaluate the impact of "bundled" physiologic targets on outcomes in VA-ECMO patients. Methods This retrospective cohort study analyzed data from the Extracorporeal Life Support Organization (ELSO) registry, including adult patients receiving VA-ECMO for CS between 2013 and 2022. Patients were grouped by whether they received the full set of bundle components within the first 24 h. The bundle included mean arterial pressure > 65 mmHg, PaO 2 60–150 mmHg, relative change in PaCO 2 [RelΔCO 2 ] > −50% (RelΔCO 2 = [(PaCO 2-24hours −PaCO 2-baseline )/PaCO 2-baseline ] ∗ 100%), and peak inspiratory pressure < 30 mmHg. The primary outcome was survival to hospital discharge, while secondary outcomes were complications. Findings Of 7950 patients (mean age 56.5 ± 14.3 years), 2762 (34.7%) received the complete bundle. The bundle group had significantly higher rates of survival to hospital discharge (55.9% vs. 39.4%, p < 0.001) with adjusted odds ratio [aOR] of 1.849 (95% CI [1.675, 2.042]; p < 0.001), and the likelihood of brain death (aOR = 0.521, 95% CI: 0.289–0.885; p = 0.021), ischemic stroke (aOR = 0.710, 95% CI: 0.559–0.896; p = 0.004), hemorrhagic complications (aOR = 0.773, 95% CI: 0.681–0.876; p < 0.001) and cardiovascular complications (aOR = 0.863, 95% CI: 0.770–0.966; p = 0.011) were reduced. Interpretation Achieving the proposed physiologic bundle is associated with improved survival and a reduced risk of complications in VA-ECMO patients with CS. These findings provide evidence supporting the use of standardized care bundles in the management of VA-ECMO patients with CS. Funding This work was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZYLX202111, to X Hou), Beijing Hospitals Authority "Ascent Plan" (No. FDL20190601, to X Hou), Young Elite Scientists Sponsorship Program by CAST (No. 2022QNRC001, to L Wang), National Natural Science Foundation of China (No. 82200433, to L Wang), and Beijing Hospitals Authority Youth Programme (No. QML20230602, to L Wang), National Natural Science Foundation of China (No. 82100408, to X Hao), Beijing Nova Program (No. 2022064, to C Li), Beijing Natural Science Foundation (No. 7244327, to C Li), and the National Key Research and Development Program of China (No. 2021YFC2701700 and 2021YFC2701703, to Z Du).
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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 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| 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".