TY - JOUR
T1 - Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS
T2 - an international Delphi study
AU - Rabie, Ahmed A.
AU - Elhazmi, Alyaa
AU - Azzam, Mohamed H.
AU - Abdelbary, Akram
AU - Labib, Ahmed
AU - Combes, Alain
AU - Zakhary, Bishoy
AU - MacLaren, Graeme
AU - Barbaro, Ryan P.
AU - Peek, Giles J.
AU - Antonini, Marta Velia
AU - Shekar, Kiran
AU - Al‐Fares, Abdulrahman
AU - Oza, Pranay
AU - Mehta, Yatin
AU - Alfoudri, Huda
AU - Ramanathan, Kollengode
AU - Ogino, Mark
AU - Raman, Lakshmi
AU - Paden, Matthew
AU - Brodie, Daniel
AU - Bartlett, Robert
N1 - Funding Information:
Dr. Brodie receives research support from and consults for LivaNova. He has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira, and Cellenkos. He is the President-elect of the Extracorporeal Life Support Organization (ELSO) and the Chair of the Executive Committee of the International ECMO Network (ECMONet). Dr. Rayan Barbaro is the Extracorporeal Life Support Organization (ELSO) Registry Chair and receives support unrelated to this work from the National Institutes of Health R01 HL153519; K12 HL138039. Dr. Alain Combes reports grants from Getinge and personal fees from Getinge, Baxter, and Xenios outside the submitted work. Dr. Akram Abdelbary received lecture fees and educational fees from Gettinge, Pfizer, Sanofi, Novartis, Bayer not related to this work. Dr. Graeme serves as global representative on the Board of Directors of ELSO. All authors declared no conflict of interest related to this work.
Funding Information:
We acknowledge and thank the KSMC ECMO research team and MOH national ECMO program team for valuable help in the design of the work and coordinating the voting process, including Dr. Waleed A. Hashem, director of the general hospital in KSMC, Riyadh-KSA. Dr. Wael F. Alblowi, Consultant Physician, Internal Medicine Department, Adult Allergy and Clinical Immunology, medical director of the general hospital in KSMC, Riyadh-KSA. Dr. Mohamed Alodat, chairman, and Dr. Rayan Alshaya, Deputy Chairman of the Critical Care Department, Riyadh region Cluster1, King Saud Medical City, Riyadh-Saudi Arabia. Dr. Waleed Alatreby, methodologist and statistician quality coordinator in the Critical Care Department, KSMC, Riyadh-SA. Mr. Bassel H. Almuabbadi, general hospital nursing department director, Riyadh-KSA. Prabhakaran G Franklin, head of the perfusion service, KSMC Riyadh-SA. We also appreciated the guest authors participation in phase III with their valuable experience that added to the work, Dr. Alia Hassan Abdelfattah, professor of critical care, Cairo University-Egypt, Dr. Mohamed Almaan, chairman of critical care department, KFMC, Riyadh-KSA Dr. Hussam Bahaldeen, critical care consultant King Abdulaziz Medical City, MNGHA, Jeddah, SA. Dr Mostafa Rajab & Dr. Mohamed Foteih Critical Care Department, Prince Mohamad bin abed Aziz hospital Riyadh-Saudi Arabia. Dr. Ayed Asiri, critical care consultant Alhayah hospital, Dr. Ali Albashabshi, critical care consultant Grace van Leeuwen, MD, FSCAI Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine—Qatar, Senior Attendin-PCICU-Sidra Medicine. Mrs. Monika Tulkas, ECMO Program Adults and Peds, Columbia University in the City of New York. The study is intended to provide ECMO practitioners with additional expert opinion in approaching debatable and controversial topics related to ECMO during the COVID-19 pandemic, in addition to their interpretation of the most recent findings of increasingly published research; however, it does not replace clinical judgment or clear evidence from literature and guidelines. Consensus is recognized as a tool of expert opinion and does not replace guidelines, randomized trials, meta-analysis, or large nonrandomized trials. It should not be used in place of any existing ELSO guidelines.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - 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.
AB - 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.
KW - COVID-19
KW - Consensus
KW - Delphi
KW - ECMO
KW - Statement
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U2 - 10.1186/s13613-023-01126-9
DO - 10.1186/s13613-023-01126-9
M3 - Article
C2 - 37129771
AN - SCOPUS:85159949580
SN - 2110-5820
VL - 13
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 36
ER -