Recommendations in Extracorporeal Cardiopulmonary Resuscitation Post Resuscitation Care Via An International, Modified Delphi Approach

Abstract

Background: The global adoption of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest is accelerating, reflecting its potential to improve outcomes in select patient populations. Although research has increasingly focused on patient selection criteria, there remains a critical lack of evidence to guide best practices in post-ECPR resuscitation management. This study aimed to identify key knowledge gaps and develop consensus-based recommendations to inform clinical decision-making in the post-ECPR setting.

Methods: An international, multidisciplinary steering committee comprising 11 ECPR experts and 1 survivor conducted a targeted literature review to identify key domains and gaps in post-ECPR care. Experts were recruited based on field impact and snowball sampling. A modified Delphi process was used, comprising 3 survey rounds. Consensus was defined a priori as ≥70% agreement or disagreement on Likert-scale statements.

Results: A total of 53 experts were recruited, representing diverse health care professions, gender, and levels of clinical experience. Of these, 52 (98%) completed all 3 rounds of the Delphi process. Consensus was reached on 126 individual statements, which were synthesized into 42 summary position statements. These recommendations span key domains of post-ECPR care, including system-level considerations, hemodynamic targets and management strategies, ventilation and oxygenation protocols, anticoagulation practices, temperature regulation, complication mitigation, weaning approaches, and neuroprognostication.

Conclusions: This modified Delphi study, informed by a diverse international panel, resulted in 42 consensus-based position statements addressing key aspects of post-ECPR care. In the absence of robust empirical evidence, these expert-derived recommendations offer a valuable framework to support clinical decision-making and the development of standardized post-ECPR resuscitation protocols.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06552312.

Keywords: ECMO; ECPR; cardiopulmonary resuscitation; extracorporeal membrane oxygenation; post resuscitation.