Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study.

Autor: Rabie AA; Critical Care Department-ECMO care Unit (ECU), Riyadh Region Cluster1, King Saud Medical City, Riyadh, Saudi Arabia. drarabie@ksmc.med.sa., Elhazmi A; Internal Medicine Department, King Faisal University, Riyadh, Saudi Arabia., Azzam MH; Adult Critical Care Department, Dr. Sulaiman Alhabib Medical Group, Jeddah, Saudi Arabia., Abdelbary A; Critical Care Department, Cairo University, Cairo, Egypt., Labib A; Hamad Medical Corporation, Weill Cornell Medical College, Doha, Qatar., Combes A; INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013, Paris, France.; Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France., Zakhary B; Oregon Health and Science University, Portland, OR, USA., MacLaren G; Cardiothoracic ICU, National University Hospital, Singapore, Singapore., Barbaro RP; Division of Pediatric Critical Care and Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA., Peek GJ; Congenital Heart Center, University of Florida, Gainesville, FL, USA., Antonini MV; General Intensive Care Unit, University Hospital of Parma, Parma, Italy., Shekar K; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.; Faculty of Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia., Al-Fares A; Department of Anesthesia, Critical Care Medicine and Pain Medicine, Ministry of Health, Kuwait City, Kuwait.; Al-Amiri Hospital Center for Respiratory and Cardiac Failure, Kuwait Extracorporeal Life Support Program, Ministry of Health, Kuwait City, Kuwait., Oza P; Riddhi Vinayak Multispecialty Hospital, Mumbai, India., Mehta Y; Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, 122001, Haryana, India., Alfoudri H; Department of Anaesthesia, Critical Care, and Pain Management, Al-Adan Hospital Ministry of Health, Hadiya, Kuwait., Ramanathan K; Cardiothoracic ICU, National University Hospital, Singapore, Singapore., Ogino M; Chief Partnership Officer, Nemours Children's Health, Delaware Valley, USA., Raman L; Division of Paediatric Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX, USA., Paden M; Division of Paediatric Critical Care, Emory University, Atlanta, GA, USA., Brodie D; Department of Medicine, Columbia University College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian/Columbia University Medical Center, New York, USA., Bartlett R; University of Michigan, Ann Arbor, MI, USA.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2023 May 02; Vol. 13 (1), pp. 36. Date of Electronic Publication: 2023 May 02.
DOI: 10.1186/s13613-023-01126-9
Abstrakt: Background: The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus.
Objectives: To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS.
Methods: The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel's questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively.
Results: In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics.
Conclusion: Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations.
(© 2023. The Author(s).)
Databáze: MEDLINE
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