ECPR2: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation

Florian F Schmitzberger; Nathan L Haas; Ryan A Coute; Jason Bartos; Amy Hackmann; Jonathan W Haft; Cindy H Hsu; Alice Hutin; Lionel Lamhaut; Jon Marinaro; Ken Nagao; Takahiro Nakashima; Robert Neumar; Vincent Pellegrino; Zack Shinar; Sage P Whitmore; Demetri Yannopoulos; William J Peterson

doi:10.1016/j.resuscitation.2022.07.003

ECPR²: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation

Resuscitation. 2022 Oct:179:214-220. doi: 10.1016/j.resuscitation.2022.07.003. Epub 2022 Jul 8.

Authors

Florian F Schmitzberger¹, Nathan L Haas², Ryan A Coute³, Jason Bartos⁴, Amy Hackmann⁵, Jonathan W Haft⁶, Cindy H Hsu², Alice Hutin⁷, Lionel Lamhaut⁷, Jon Marinaro⁸, Ken Nagao⁹, Takahiro Nakashima¹⁰, Robert Neumar², Vincent Pellegrino¹¹, Zack Shinar¹², Sage P Whitmore¹³, Demetri Yannopoulos¹⁴, William J Peterson¹⁵

Affiliations

¹ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: fschmitz@med.umich.edu.
² Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA.
³ Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
⁴ Division of Cardiology, Department of Medicine, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
⁵ Department of Cardiovascular and Thoracic Surgery, UTSouthwestern, Parkland Hospital, Dallas, TX, USA.
⁶ Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
⁷ SAMU de Paris, Assistance Publique - Hôpitaux de Paris, Necker University Hospital, Paris, France.
⁸ Department of Emergency Medicine, Division of Critical Care, University of New Mexico, Albuquerque, NM, USA.
⁹ Department of Cardiology, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan.
¹⁰ Department of Emergency Medicine, Division of Critical Care, Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI, USA.
¹¹ ECMO Clinical Service Alfred Health, Melbourne Australia.
¹² Department of Emergency Medicine, Sharp Memorial Hospital, San Diego CA, USA.
¹³ Critical Care Medicine, TriStar Centennial Medical Center, Nashville, TN, USA.
¹⁴ Division of Cardiology, Center for Resuscitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN.
¹⁵ Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.

PMID: 35817270
DOI: 10.1016/j.resuscitation.2022.07.003

Abstract

Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ECPR initiation after OHCA.

Methods: We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale.

Results: Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and five primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 207 items. The panel reached consensus on 101 items meeting final criteria for inclusion: Prior to Patient Arrival (13 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (18), and Post-Cannulation (26).

Conclusion: We present a list of items for ECPR initiation following adult nontraumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings may benefit centers currently performing ECPR in quality assurance and serve as a template for new ECPR programs.

Keywords: Cardiac arrest; Delphi; ECPR; OHCA.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiopulmonary Resuscitation* / methods
Catheterization
Consensus
Extracorporeal Membrane Oxygenation* / methods
Humans
Out-of-Hospital Cardiac Arrest* / therapy
Retrospective Studies

Grants and funding

R01 HL133129/HL/NHLBI NIH HHS/United States