背景:管理需要体外膜氧合(ECMO)支持的COVID-19患者的高质量证据不足。此外,在稀缺时分配ECMO资源几乎没有共识。缺乏证据和需要就有争议的话题提供指导,需要国际专家达成共识,以更好地理解ECMO在COVID-19中的作用。全球22位国际ECMO专家共同努力,解释不断发展的已发表研究的最新发现,声明表述,投票达成共识。
目的:在未来的流行病中指导下一代ECMO从业人员解决与COVID-19相关的严重ARDS患者使用ECMO有关的有争议的话题。
方法:科学委员会由五名主席组成,他们具有5年以上的ECMO经验和重症监护背景。他们的角色是修改和重组小组的问题,除了专家组成和文献综述外,还协助陈述的制定。根据他们在ECMO(至少5年)的临床经验和以前在全球范围内的学术活动来确定专家。关注性别的多样性,地理,专业领域,和资历水平。我们通过三个面对面的会议使用了修改后的Delphi技术回合和名义组技术(NGT),并且匿名进行了声明投票。整个过程计划分五个阶段进行:确定知识差距,验证,声明表述,投票,和起草,分别。
结果:在第一阶段,科学委员会在COVID-19的ECMO中获得了52个关于有争议主题的问题,进一步审查了第二阶段的重复和冗余,导致9个领域有32个问题,验证率超过75%(图。1).在第三阶段,25个问题被用来制定14个陈述,六个问题没有达成共识。在第四阶段,两轮投票导致14项声明达成共识,包括四个领域:患者选择,ECMO临床管理,运营和物流管理,和道德。
结论:COVID-19发病三年后,我们对ECMO作用的理解已经发展。然而,它是不完整的。Tota14声明达成共识;包括在四个领域讨论患者选择,临床ECMO管理,运营和后勤ECMO管理和道德规范,以在未来大流行情况下指导下一代ECMO提供者。
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.
OBJECTIVE: 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.
CONCLUSIONS: 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.