Abstract 9897: Impact of Extracorporeal Membrane Oxygenation and Cardiopulmonary Resuscitation on Norwood Procedure Outcomes: Data from the Single Ventricle Reconstruction Trail
Bibliographic record
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) and cardiopulmonary resuscitation (CPR) are reported risk factors for worse outcome after the Norwood procedure (NP). The Single Ventricle Reconstruction (SVR) trial randomized infants with hypoplastic left heart syndrome to a modified Blalock-Taussig shunt (MBTS) or right ventricular to pulmonary artery shunt (RVPAS). We explored associations between ECMO and/or CPR with death and transplant. Methods: Outcomes for 549 SVR patients using the shunt in place at end of the NP (MBTS 268, RVPAS 281) were compared among: CPR alone (CPR, n=37), ECMO alone (ECMO, n=49), ECMO required to regain circulation after CPR (E-CPR, n=36) and neither CPR nor ECMO (“none”, n=427). Cox proportional hazards regression with a time-dependent group indicator was used to model time to death or transplant. The interaction of patient group and shunt type was also examined. Results: Mean follow-up was 2.7 ± 1.9 years. Gestational age, age at surgery, size of ascending aorta, presence of significant tricuspid regurgitation, systolic function and shunt type were similar among the 4 groups. Low birth weight was more common in CPR or E-CPR groups (p<.001). Patients receiving CPR, ECMO or E-CPR had a higher incidence of transplant or death (p<.0001). With adjustment for surgeon and birth weight, interaction analysis showed poorer outcome with MBTS in the “none” group but not in the E-CPR group (interaction p = .014). The hazard ratio for MBTS vs. RVPAS in E-CPR was 0.48 (95% CI 0.21, 1.11) vs. 1.54 (95% CI 1.04, 2.28) for “none”. A similar pattern was seen with ECMO (interaction p = .047). A differential effect of shunt type was not observed for CPR vs. “none” patients. Conclusions: Patients requiring CPR and/or ECMO after the Norwood procedure have significantly increased early mortality and/or transplant and remain at risk for attrition remote from the initial event. The RVPAS was not found to be superior to the MBTS in patients requiring ECMO or E-CPR.
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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 | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".