Abstract：
OBJECTIVE: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an integral part of the management algorithm of patients with severe respiratory failure refractory to evidence-based conventional treatments. Right ventricular injury (RVI) pertaining to abnormalities in the dimensions and/or function of the right ventricle (RV) in the context of VV-ECMO significantly influences mortality. However, in the absence of a universally accepted RVI definition and evidence-based guidance for the management of RVI in this very high-risk patient cohort, variations in clinical practice continue to exist.
METHODS: Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions.
RESULTS: The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes.
CONCLUSIONS: The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.
METHODS: Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions.
RESULTS: The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes.
CONCLUSIONS: The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.
摘要：
目的：静脉-静脉体外膜肺氧合（VV-ECMO）是循证常规治疗难以治疗的严重呼吸衰竭患者管理算法的组成部分。在VV-ECMO的背景下，与右心室（RV）的尺寸和/或功能异常有关的右心室损伤（RVI）显着影响死亡率。然而,在缺乏普遍接受的RVI定义和基于证据的RVI管理指南的情况下，临床实践中的变化继续存在。
方法：在对文献进行系统搜索之后，一个国际指导委员会,由8名医疗保健专业人员组成,参与对接受ECMO治疗的患者的管理,确定了与RVI定义和管理相关的领域和知识差距,证据有限或含糊不清.使用Delphi过程，一个由52名专家组成的国际小组编写了这些领域的专家立场声明。该过程还为未来的研究提供了以RV为中心的总体开放问题。共识被定义为当70％或更多的专家同意或不同意李克特量表的声明时，或者当80％或更多的专家同意多项选择题中的特定选项时。
结果：Delphi过程通过四轮进行，对35种陈述中的31种（89％）达成共识，从中得出24种专家立场陈述。专家立场声明为VV-ECMO设置中的RVI命名法提供了建议，RVI的多模态诊断方法，诊断超声心动图的时间和参数，RVI评估和管理期间的VV-ECMO设置。在RV保护性驱动压力阈值或俯卧位对以患者为中心的结果的影响方面未达成共识。
结论：在VV-ECMO背景下提出的RVI定义需要通过系统汇总研究数据来验证。在进一步的证据出现之前，专家立场声明可以指导这些患者的管理决策。
方法：在对文献进行系统搜索之后，一个国际指导委员会,由8名医疗保健专业人员组成,参与对接受ECMO治疗的患者的管理,确定了与RVI定义和管理相关的领域和知识差距,证据有限或含糊不清.使用Delphi过程，一个由52名专家组成的国际小组编写了这些领域的专家立场声明。该过程还为未来的研究提供了以RV为中心的总体开放问题。共识被定义为当70％或更多的专家同意或不同意李克特量表的声明时，或者当80％或更多的专家同意多项选择题中的特定选项时。
结果：Delphi过程通过四轮进行，对35种陈述中的31种（89％）达成共识，从中得出24种专家立场陈述。专家立场声明为VV-ECMO设置中的RVI命名法提供了建议，RVI的多模态诊断方法，诊断超声心动图的时间和参数，RVI评估和管理期间的VV-ECMO设置。在RV保护性驱动压力阈值或俯卧位对以患者为中心的结果的影响方面未达成共识。
结论：在VV-ECMO背景下提出的RVI定义需要通过系统汇总研究数据来验证。在进一步的证据出现之前，专家立场声明可以指导这些患者的管理决策。
