Expert consensus on training and accreditation for extracorporeal cardiopulmonary resuscitation an international, multidisciplinary modified Delphi Study

Natalie Kruit*, Aidan Burrell, David Tian, Nicholas Barrett, Jan Bělohlávek, Stephen Bernard, Darren Braude, Hergen Buscher, Yih Sharng Chen, Dirk W. Donker, Simon Finney, Paul Forrest, Jo anne Fowles, Toru Hifumi, Carol Hodgson, Alice Hutin, Akihiko Inoue, Jae Seung Jung, J. M. Kruse, Lionel LamhautRichard Ming-Hui Lin, Dinis Reis Miranda, Thomas Müller, Vinodh Bhagyalakshmi Nanjayya, Christopher Nickson, Vin Pellegrino, Brian Plunkett, Carla Richardson, Sacha Alexander Richardson, Kiran Shekar, Zachary Shinar, Ben Singer, Dion Stub, Richard J. Totaro, Alain Vuylsteke, Demetris Yannopoulos, Bishoy Zakhary, Mark Dennis

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: A multidisciplinary group of stakeholders were used to identify: (1) the core competencies of a training program required to perform in-hospital ECPR initiation (2) additional competencies required to perform pre-hospital ECPR initiation and; (3) the optimal training method and maintenance protocol for delivering an ECPR program. Methods: A modified Delphi process was undertaken utilising two web based survey rounds and one virtual meeting. Experts rated the importance of different aspects of ECPR training, competency and governance on a 9-point Likert scale. A diverse, representative group was targeted. Consensus was achieved when greater than 70% respondents rated a domain as critical (> or = 7 on the 9 point Likert scale). Results: 35 international ECPR experts from 9 countries formed the expert panel, with a median number of 14 years of ECMO practice (interquartile range 11–38). Participant response rates were 97% (survey round one), 63% (virtual meeting) and 100% (survey round two). After the second round of the survey, 47 consensus statements were formed outlining a core set of competencies required for ECPR provision. We identified key elements required to safely train and perform ECPR including skill pre-requisites, surrogate skill identification, the importance of competency-based assessment over volume of practice and competency requirements for successful ECPR practice and skill maintenance. Conclusions: We present a series of core competencies, training requirements and ongoing governance protocols to guide safe ECPR implementation. These findings can be used to develop training syllabus and guide minimum standards for competency as the growth of ECPR practitioners continues.

Original languageEnglish
Article number109989
Number of pages10
Early online date5 Oct 2023
Publication statusPublished - Nov 2023


  • 2024 OA procedure
  • Extracorporeal life support (ECLS)
  • Pre-hospital, extracorporeal cardiopulmonary resuscitation (E-CPR)
  • Venoarterial extracorporeal membrane oxygenation (VA ECMO)
  • Advanced cardiopulmonary resuscitation


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