Veno-venous versus Veno-arterial extracorporeal membrane oxygenation for the management of primary graft dysfunction following lung transplantation: A systematic review and meta-analysis
Bibliographic record
Abstract
Background: Primary graft dysfunction (PGD) is the leading cause of early morbidity and mortality after lung transplantation. In its severe forms, extracorporeal membrane oxygenation (ECMO) may be required. However, there is no consensus on whether venovenous (VV) or venoarterial (VA) ECMO modality provides superior outcomes. The objective of this meta-analysis is to compare the use of VV-ECMO versus VA-ECMO in the management of grade 3 PGD after lung transplantation. Methods: Three databases were assessed. Primary outcome was overall survival (OS). Secondary outcomes included cerebrovascular complications, incidence of pneumonia, reintubation, acute kidney injury, ICU length of stay and ECMO duration. Hazard ratios (HR), odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated. Reconstruction of time-to-event data and sensitivity analyses were performed for the primary endpoint. Results: Four studies including 210 patients (VV-ECMO: 142; VA-ECMO: 68) were analyzed. VV-ECMO was associated with improved early survival (HR 0.41; 95%CI 0.22 to 0.76; p=0.005) within the first 2 months after transplantation, although no significant difference was observed in long-term survival (HR 0.72; 95%CI 0.46 to 1.15; p=0.168). Cerebrovascular complications occurred significantly more often in the VA-ECMO group (OR 18.33; 95%CI 3.62 to 92.81; p=0.0004), while no significant differences were found in pneumonia, reintubation, acute renal failure, ICU length of stay, or ECMO duration. Conclusion: VV-ECMO appears to be associated with better short-term survival and fewer neurological complications compared to VA-ECMO in patients with grade 3 PGD after lung transplantation.
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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 | 0.000 |
| 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".