ECPR2: Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation

• Published in: Resuscitation Vol. 179; pp. 214 - 220
• Main Authors: Schmitzberger, Florian F., Haas, Nathan L., Coute, Ryan A., Bartos, Jason, Hackmann, Amy, Haft, Jonathan W., Hsu, Cindy H., Hutin, Alice, Lamhaut, Lionel, Marinaro, Jon, Nagao, Ken, Nakashima, Takahiro, Neumar, Robert, Pellegrino, Vincent, Shinar, Zack, Whitmore, Sage P., Yannopoulos, Demetri, Peterson, William J.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-10-2022
• Subjects: Cardiac arrest; Delphi; ECPR; OHCA; ECPR; OHCA; Delphi; Cardiac arrest
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2022.07.003

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.
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.
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).
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.