Incidence and Predictors of Failed Weaning on Veno-arterial Extracorporeal Life Support (VA-ECLS): A Retrospective Cohort Study
Bibliographic record
Abstract
Venoarterial membrane oxygenation (VA-ECMO) is a form of extracorporeal life support (ECLS) that provides mechanical circulatory support (MCS) and extracorporeal gas exchange in patients who are suffering from cardiac and respiratory failure. The primary indications for VA-ECMO include cardiogenic shock, resulting from either an acute event (i.e. myocardial infarction) or worsening of chronic cardiomyopathy processes, or cardiac arrest refractory to conventional cardiopulmonary resuscitation. Broadly, VA-ECMO should be considered for patients with conditions which are refractory to conventional medical management. Formal weaning trials, performed by sequentially reducing the circuit flow, are necessary to test the heart’s ability to maintain circulation without VA-ECMO support. Timely weaning of VA-ECMO is necessary as complication rates increase significantly with the duration of support. The primary objectives of this retrospective cohort study are: 1. To determine the current rate of successful VA-ECMO weaning, and determine if implementing a VA-ECMO weaning protocol will improve incidence of successful weaning and reduce days spent on VA-ECMO. 2. To determine the factors associated with failed and successful weaning from VA-ECMO The secondary objectives of this study are: 1. To determine the factors associated with successful wean and risk factors for failed weaning. 2. To examine the outcomes of patients on VA-ECMO (30 day survival, complications) as it relates to their destination (bridge to transplant, or recovery) and location of initial cannulation. This will be a single center retrospective cohort study of patients who were placed on VA-ECLS support between Jan 2020-May 2025. This start date was chosen as it was the initiation of electronic medical records at St. Paul’s Hospital. This will include adult patients whose indications for VA-ECMO or external ventricular support included: Cardiogenic shock, in-hospital cardiac arrest (IHCA), post cardiotomy/open heart surgery (will be analyzed separately). Patients who were placed on VA-ECMO, external LVAD or biventricular VAD (BIVAD) for out of hospital cardiac arrest (OHCA) are excluded.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".