As both sentinels and effectors of disease response, peripheral blood mononuclear cells are an accessible and attractive target for clinical application of high throughput, fluidics based single cell RNASeq (scRNASeq). However, new analytic tools required by unique characteristics of scRNASeq data lack validation in acutely ill patients. We report scRNASeq analysis of ~1,000 20 cells from each of 38 patients requiring veno-arterial extracorporeal life support (VA-ECLS)-a diverse group of critically ill patients experiencing circulatory collapse as a common endpoint to wide ranging diseases. We established an analysis pipeline capturing major biological signals from theses samples, confirmed by flow cytometry. Further, we found that these patients appeared immunologically poised at the outset of treatment as either reactive or permissive, and 25 this balance predicted their survival. Annotated code detailing the analysis is available at https://github.com/vanandelinstitute/va_ecls.
Purpose There is limited research on the use and outcomes of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) treatment for massive pulmonary embolism (PE). This study compared VA-ECMO treatment for massive PE versus patients treated medically. Materials and methods Patients diagnosed with massive PE at one hospital system were reviewed. VA-ECMO and non-ECMO groups were compared by t test and Chi-square. Mortality risk factors were identified by logistic regression. Survival was assessed by Kaplan Meier and propensity matching of groups. Results Ninety-two patients were included (22 VA-ECMO and 70 non-ECMO). Age (OR 1.08, 95% CI 1.03–1.13), arterial SBP (OR 0.97, 95% CI 0.94–0.99), albumin (OR 0.3, 95% CI 0.1–0.8), and phosphorus (OR 2.0, 95% CI 1.4–3.17) were independently associated with 30-day mortality. Alkaline phosphate (OR 1.03, 95% CI 1.01–1.05) and SOFA score (OR 1.3, 95% CI 1.06–1.51) were associated with 1-year mortality. Propensity matching showed no difference in 30-day (59% VA-ECMO versus 72% non-ECMO, p = 0.363) or 1-year survival (50% VA-ECMO versus 64% non-ECMO, p = 0.355). Conclusions Patients treated with VA-ECMO for massive PE and medically treated patients have similar short- and long-term survival. Further research is needed to define clinical recommendations and benefits of intensive therapy such as VA-ECMO in this critically ill population.
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