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Journal Article Ppublish 6 citations

PubMed: 39102027 DOI: 10.1007/s00134-024-07551-z

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 Med 50(9):1411-1425

Authors: Vasileios Zochios, Prashant Nasa, Hakeem Yusuff, Marcus J Schultz, Marta Velia Antonini, Abhijit Duggal, Siddharth Dugar, Kollengode Ramanathan, Kiran Shekar, Matthieu Schmidt

Affiliations

  • Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK.
  • Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
  • Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
  • Internal Medicine, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates.
  • Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK.
  • Department of Respiratory Sciences, University of Leicester, Leicester, UK.
  • Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands.
  • Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
  • Nuffield Department of Medicine, University of Oxford, Oxford, UK.
  • Department of Anesthesiology, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
  • Intensive Care Unit, Bufalini Hospital, AUSL Della Romagna, Cesena, Italy.
  • PhD program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy.
  • Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
  • Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA.
  • National University Hospital, Singapore, 119074, Singapore.
  • Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
  • Adult Intensive Care Services, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
  • Queensland University of Technology, Brisbane, QLD, Australia.
  • University of Queensland, Brisbane and Bond University, Gold Coast, QLD, Australia.
  • Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013, Paris, France.

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.

MeSH

Delphi Technique, Extracorporeal Membrane Oxygenation, Multiple Chronic Conditions, Critical Care, Intensive Care Units, Membranes

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