Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study Annals of Intensive Care
Abstract Methods Results Discussion Conclusion Supplementary Information 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-023-01126-9.
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Ahmed A. Rabie, Alyaa Elhazmi, Mohamed H. Azzam et al.. Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study. Annals of Intensive Care. (2023). https://doi.org/10.1186/s13613-023-01126-9 Ahmed A. Rabie, Alyaa Elhazmi, Mohamed H. Azzam, Akram Abdelbary, Ahmed Labib, Alain Combes, Bishoy Zakhary, Graeme MacLaren, Ryan P. Barbaro, Giles J. Peek, Marta Velia Antonini, Kiran Shekar, Abdulrahman Al‐Fares, Pranay Oza, Yatin Mehta, Huda Alfoudri, Kollengode Ramanathan, Mark Ogino, Lakshmi Raman, Matthew Paden, Daniel Brodie, Robert Bartlett
1grid.415998.80000 0004 0445 6726Critical Care Department-ECMO care Unit (ECU), Riyadh Region Cluster1, King Saud Medical City, Riyadh, Saudi Arabia 2grid.412140.20000 0004 1755 9687Internal Medicine Department, King Faisal University, Riyadh, Saudi Arabia 3grid.513094.aAdult Critical Care Department, Dr. Sulaiman Alhabib Medical Group, Jeddah, Saudi Arabia 4grid.7776.10000 0004 0639 9286Critical Care Department, Cairo University, Cairo, Egypt 5grid.413548.f0000 0004 0571 546XHamad Medical Corporation, Weill Cornell Medical College, Doha, Qatar 6grid.462844.80000 0001 2308 1657INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013 Paris, France 7grid.411439.a0000 0001 2150 9058Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013 Paris, France 8grid.5288.70000 0000 9758 5690Oregon Health and Science University, Portland, OR USA 9grid.412106.00000 0004 0621 9599Cardiothoracic ICU, National University Hospital, Singapore, Singapore 10grid.214458.e0000000086837370Division of Pediatric Critical Care and Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI USA 11grid.15276.370000 0004 1936 8091Congenital Heart Center, University of Florida, Gainesville, FL USA 12grid.411482.aGeneral Intensive Care Unit, University Hospital of Parma, Parma, Italy 13grid.415184.d0000 0004 0614 0266Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD Australia 14grid.1024.70000000089150953Faculty of Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia 15grid.415706.10000 0004 0637 2112Department of Anesthesia, Critical Care Medicine and Pain Medicine, Ministry of Health, Kuwait City, Kuwait 16grid.415706.10000 0004 0637 2112Al‐Amiri Hospital Center for Respiratory and Cardiac Failure, Kuwait Extracorporeal Life Support Program, Ministry of Health, Kuwait City, Kuwait 17Riddhi Vinayak Multispecialty Hospital, Mumbai, India 18grid.429252.a0000 0004 1764 4857Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, 122001 Haryana India 19grid.415706.10000 0004 0637 2112Department of Anaesthesia, Critical Care, and Pain Management, Al‐Adan Hospital Ministry of Health, Hadiya, Kuwait 20grid.414196.f0000 0004 0393 8416Chief Partnership Officer, Nemours Children’s Health, Delaware Valley, USA 21grid.267313.20000 0000 9482 7121Division of Paediatric Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX USA 22grid.189967.80000 0001 0941 6502Division of Paediatric Critical Care, Emory University, Atlanta, GA USA 23grid.21729.3f0000000419368729Department of Medicine, Columbia University College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian/Columbia University Medical Center, New York, USA 24grid.214458.e0000000086837370University of Michigan, Ann Arbor, MI USA 