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The aim of this study was to investigate the key issues of the treatment of ECPR and to preliminarily achieve the clinical expert consensus of ECPR suitable for China's national conditions.
We analyzed the domestic and overseas literatures of ECPR and designed questionnaires by using Delphi method. Experts of extracorporeal circulation and critical care medicine were selected to conduct the survey. The questionnaires included the key issues of the treatment of ECPR, such as the definition of ECPR, the selection of patients, the clinical management of ECMO,etc. After the collection of the first round questionnaires, data was analyzed by the research group and the second round questionnaires were designed.SPSS 22.0 was used to analyze the result, including the concentration and coordination of the experts'opinions and the reliability of the questionnaires. The clinical expert consensus of ECPR was achieved after analyzing the items of the questionnaires.
A total of two rounds of expert consultation were conducted. The first round investigation included 25 experts that all of whom were in senior positions and had worked over 10 years. The positive coefficient of the experts was 100%. In the first round, over 95% of the experts agreed that the definition of ECPR was CPR assisted by ECMO for patients who couldn't achieve ROSC after CPR over 20 minutes or those couldn't maintain ROSC because of repeating heart arrest. Over 70% of the experts agreed that the indications of ECPR were cardiogeic cardiac arrest, pulmonary embolism, cardiogenic shock and heart arrest caused by hypothermia or toxication. The contraindications of ECPR incuded brain death or irreversible brain injury, uncontrollable hemorrhage, terminal malignant tumors and consent of termination of treatment. The first round investigation achieved 30 consensuses, including medical monitoring during ECPR, the indications of weaning ECMO off, as well as the definition of ECPR,etc. The second round investigation focused on controversial items and expert opinions of newly suggested. All the experts engaged in the first round and had worked over 15 years. All the members belonged to the association of critical care medicine or the association of extracorporeal circulation in China. The second round investigation included 20 experts and the positive coefficient of the experts was 100%.16 consensuses were achieved during the second round. The average coefficient of variation sharply decreased during the second round (CV=0.302) compared with the first round (CV=0.854). The average reliability increased from 0.665 to 0.884. The result was reliable and we could terminate the consultation. After analyzing the result, the clinical expert consensus of ECPR was achieved.
By using Delphi method, we investigated and analyzed the key issues of the treatment of ECPR. The achievement of the clinical expert consensus of ECPR will facilitate the application of ECPR.