TY - JOUR
T1 - Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study
T2 - Expert position statements
AU - Zochios, Vasileios
AU - Nasa, Prashant
AU - Yusuff, Hakeem
AU - Schultz, Marcus J.
AU - Antonini, Marta Velia
AU - Duggal, Abhijit
AU - Dugar, Siddharth
AU - Ramanathan, Kollengode
AU - Shekar, Kiran
AU - Schmidt, Matthieu
AU - Agerstrand, Cara
AU - Akkanti, Bindu
AU - Badulak, Jenelle
AU - Vieillard-Baron, Antoine
AU - Brogan, Thomas V.
AU - Brodie, Daniel
AU - Cain, Michael
AU - Camporota, Luigi
AU - Combes, Alain
AU - Cornwell, William
AU - Donker, Dirk W.
AU - Douflé, Ghislaine
AU - Fan, Eddy
AU - Finney, Simon
AU - Haji, Jumana Yusuf
AU - Hassoun, Paul M.
AU - Hemnes, Anna
AU - Isgro, Graziella
AU - Jones, Nicola
AU - Joyce, David
AU - Karagiannidis, Christian
AU - Khorsandi, Maziar
AU - Lahm, Tim
AU - Lazzeri, Chiara
AU - Ledot, Stephane
AU - Levy, David
AU - Liliequist, Andreas
AU - Lim, Hoong Sern
AU - MacLaren, Graeme
AU - Maybauer, Marc O.
AU - Nair, Priya
AU - Nickson, Chris
AU - Vonk Noordegraaf, Anton
AU - Parhar, Ken
AU - Peek, Giles
AU - Pettenuzzo, Tommaso
AU - Pinsky, Michael R.
AU - Price, Susanna
AU - Qadir, Nida
AU - Read, Matthew
AU - and the Protecting the Right Ventricle network (PRORVnet)
N1 - Publisher Copyright:
© Crown 2024.
PY - 2024/9
Y1 - 2024/9
N2 - Purpose: 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. Conclusion: 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.
AB - Purpose: 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. Conclusion: 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.
KW - n/a OA procedure
KW - ECMO
KW - Extracorporeal membrane oxygenation
KW - Respiratory failure
KW - Right ventricular failure
KW - ARDS
UR - http://www.scopus.com/inward/record.url?scp=85201951643&partnerID=8YFLogxK
U2 - 10.1007/s00134-024-07551-z
DO - 10.1007/s00134-024-07551-z
M3 - Article
C2 - 39102027
AN - SCOPUS:85201951643
SN - 0342-4642
VL - 50
SP - 1411
EP - 1425
JO - Intensive care medicine
JF - Intensive care medicine
IS - 9
ER -