Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements
1
Issued Date
2024-01-01
Resource Type
ISSN
03424642
eISSN
14321238
Scopus ID
2-s2.0-85201951643
Pubmed ID
39102027
Journal Title
Intensive Care Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Intensive Care Medicine (2024)
Suggested Citation
Zochios V., Nasa P., Yusuff H., Schultz M.J., Antonini M.V., Duggal A., Dugar S., Ramanathan K., Shekar K., Schmidt M., Zakhary B., Zaaqoq A., Vuylsteke A., Ventetuolo C., Valchanov K., Usman A., Tonna J.E., Swol J., Šribar A., Slobod D., Slaughter M.S., Shelley B., Read M., Qadir N., Price S., Pinsky M.R., Pettenuzzo T., Peek G., Parhar K., Noordegraaf A.V., Nickson C., Nair P., Maybauer M.O., MacLaren G., Lim H.S., Liliequist A., Levy D., Ledot S., Lazzeri C., Lahm T., Khorsandi M., Karagiannidis C., Joyce D., Jones N., Isgro G., Hemnes A., Hassoun P.M., Haji J.Y., Finney S., Fan E., Douflé G., Donker D.W., Cornwell W., Combes A., Camporota L., Cain M., Brodie D., Brogan T.V., Vieillard-Baron A., Badulak J., Akkanti B., Agerstrand C. Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements. Intensive Care Medicine (2024). doi:10.1007/s00134-024-07551-z Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/100688
Title
Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements
Author(s)
Zochios V.
Nasa P.
Yusuff H.
Schultz M.J.
Antonini M.V.
Duggal A.
Dugar S.
Ramanathan K.
Shekar K.
Schmidt M.
Zakhary B.
Zaaqoq A.
Vuylsteke A.
Ventetuolo C.
Valchanov K.
Usman A.
Tonna J.E.
Swol J.
Šribar A.
Slobod D.
Slaughter M.S.
Shelley B.
Read M.
Qadir N.
Price S.
Pinsky M.R.
Pettenuzzo T.
Peek G.
Parhar K.
Noordegraaf A.V.
Nickson C.
Nair P.
Maybauer M.O.
MacLaren G.
Lim H.S.
Liliequist A.
Levy D.
Ledot S.
Lazzeri C.
Lahm T.
Khorsandi M.
Karagiannidis C.
Joyce D.
Jones N.
Isgro G.
Hemnes A.
Hassoun P.M.
Haji J.Y.
Finney S.
Fan E.
Douflé G.
Donker D.W.
Cornwell W.
Combes A.
Camporota L.
Cain M.
Brodie D.
Brogan T.V.
Vieillard-Baron A.
Badulak J.
Akkanti B.
Agerstrand C.
Nasa P.
Yusuff H.
Schultz M.J.
Antonini M.V.
Duggal A.
Dugar S.
Ramanathan K.
Shekar K.
Schmidt M.
Zakhary B.
Zaaqoq A.
Vuylsteke A.
Ventetuolo C.
Valchanov K.
Usman A.
Tonna J.E.
Swol J.
Šribar A.
Slobod D.
Slaughter M.S.
Shelley B.
Read M.
Qadir N.
Price S.
Pinsky M.R.
Pettenuzzo T.
Peek G.
Parhar K.
Noordegraaf A.V.
Nickson C.
Nair P.
Maybauer M.O.
MacLaren G.
Lim H.S.
Liliequist A.
Levy D.
Ledot S.
Lazzeri C.
Lahm T.
Khorsandi M.
Karagiannidis C.
Joyce D.
Jones N.
Isgro G.
Hemnes A.
Hassoun P.M.
Haji J.Y.
Finney S.
Fan E.
Douflé G.
Donker D.W.
Cornwell W.
Combes A.
Camporota L.
Cain M.
Brodie D.
Brogan T.V.
Vieillard-Baron A.
Badulak J.
Akkanti B.
Agerstrand C.
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
College of Life Sciences
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
College of Medicine and Health Sciences United Arab Emirates University
NMC Specialty Hospital
University of Leicester
National University Hospital
The University of Queensland
Alma Mater Studiorum Università di Bologna
NUS Yong Loo Lin School of Medicine
Cleveland Clinic Foundation
Ospedale M. Bufalini
Hôpital Universitaire Pitié Salpêtrière
Medizinische Universität Wien
Queensland University of Technology
Glenfield Hospital
Nuffield Department of Medicine
The Prince Charles Hospital
Amsterdam UMC - University of Amsterdam
College of Life Sciences
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
College of Medicine and Health Sciences United Arab Emirates University
NMC Specialty Hospital
University of Leicester
National University Hospital
The University of Queensland
Alma Mater Studiorum Università di Bologna
NUS Yong Loo Lin School of Medicine
Cleveland Clinic Foundation
Ospedale M. Bufalini
Hôpital Universitaire Pitié Salpêtrière
Medizinische Universität Wien
Queensland University of Technology
Glenfield Hospital
Nuffield Department of Medicine
The Prince Charles Hospital
Amsterdam UMC - University of Amsterdam
Corresponding Author(s)
Other Contributor(s)
Abstract
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.