A Modified Delphi for ECPR Post Resuscitation Care

The objective of this study is to generate expert consensus statements on the management of out of hospital cardiac arrest (OHCA) patients treated with extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR).

The study will be performed using a modified Delphi process with an international expert panel to generate recommendation statements related to the management of patients treated with ECPR and to determine the level of agreement for each statement from the panel as a whole. The following topics will be covered: Sedation Mechanical ventilation management Oxygen management Carbon dioxide management Haemodynamic management ECMO flow management Mean arterial pressure targets Aortic valve not opening management Left ventricular unloading/venting Complication management Infection prevention Anticoagulation Imaging Prognostication and neuro-prognostication Practical recommendations Organ donation Patient followup Cannulation will not be covered as this has been covered in other Delphi processes. Management Consensus is achieved through iterative rounds of survey and revision to the statements until a pre-determined level of agreement is met (\>70% agreement). Part 1: planning and evidence review Series of planning sessions with co-chairs Literature is reviewed/summarized Initial statements will be developed based on evidence and study team expertise Expert panel selection: The study team identified experts on ECPR for OHCA based on contributions to the field, clinical experiences, range of specialties and peer-reviewed publications with prioritization of diversity in geography and expertise. Using snowball sampling, investigators will ask the recruited experts to identify additional content experts to participate in the expert panel. It is aimed to recruit a total of 50 experts, in accordance with the recommended panel number of \>30 as outlined in the original Delphi method paper. To avoid any bias, the study team will not participate in the voting process. The survey and voting process will be online and anonymous to avoid any reciprocal influence. Part 2: Survey to achieve consensus Survey, based on the initial statements developed by study team, will be developed. This will be reviewed by independent contributors (not part of the study team or the expert panel), to ensure validity, appropriate topic coverage and length. Some questions will enable a Yes/No or quantitative response. Others will be utilising a Likert scale. The voting process will be anonymous to avoid any reciprocal influence or dredging effects and done with Research and Development/University of California, Los Angeles (RAND/UCLA) Appropriateness Method Scale. Experts will be asked to rate the importance of each item for ECPR for OHCA using the Grading of Recommendations Assessment, Development and evaluation scale from 1 (strongly disagree) to 9 (strongly agree). Statements will be classified as strong agreement (median score 7-9), neither agree or disagree (median score 4-6), or strongly disagree (median score 1-3). Panel members will also provided an "Unable to Score" response to use if they did not feel comfortable rating any specific domain. Recipients will be asked to trial.show_full_description

Inclusion: Identified experts on ECPR for OHCA based on contributions to the field, clinical experiences, range of specialties and peer-reviewed publications with prioritization of diversity in geography and expertise. Using snowball sampling, we asked the recruited experts to identify additional content experts to participate in the expert panel. We will aim to recruit a total of 50 experts, in accordance with the recommended panel number of \>30 as outlined in the original Delphi method paper. Exclusion Study team members.