• Florian F Schmitzberger, Nathan L Haas, Ryan A Coute, Jason Bartos, Amy Hackmann, Jonathan W Haft, Cindy H Hsu, Alice Hutin, Lionel Lamhaut, Jon Marinaro, Ken Nagao, Takahiro Nakashima, Robert Neumar, Vincent Pellegrino, Zack Shinar, Sage P Whitmore, Demetri Yannopoulos, and William J Peterson.
• Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: fschmitz@med.umich.edu.
• Resuscitation. 2022 Oct 1; 179: 214-220.

AimExtracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering from refractory out-of-hospital cardiac arrest (OHCA), though limited data exist regarding the best practices for ECPR initiation after OHCA.MethodsWe utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. A modified Delphi process builds content validity and is an accepted method to develop consensus by eliciting expert opinions through multiple rounds of questionnaires. Consensus was achieved when items reached a high level of agreement, defined as greater than 80% responses for a particular item rated a 4 or 5 on a 5-point Likert scale.ResultsSnowball sampling generated a panel of 14 content experts, composed of physicians from four continents and five primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 207 items. The panel reached consensus on 101 items meeting final criteria for inclusion: Prior to Patient Arrival (13 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (18), and Post-Cannulation (26).ConclusionWe present a list of items for ECPR initiation following adult nontraumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings may benefit centers currently performing ECPR in quality assurance and serve as a template for new ECPR programs.Copyright © 2022 Elsevier B.V. All rights reserved.

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