P125: Introduction of extracorporeal cardiopulmonary resuscitation (ECPR) into emergency care: a feasibility study

Introduction: Traditionally, out of hospital cardiac arrests (CA) have poor outcomes. Incorporation of extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly to supplement ACLS to provide better outcomes for patients. Current literature suggests potentially improved outcomes, including neurological function. We assessed the feasibility of introduction of ECPR to a regional hospital using a 4-phase study. We report phase-1, an estimation of the number of potential candidates for ECPR in our setting. Methods: Following development and agreement on local criteria for selection of patients for ECPR using a modified Delphi Technique, inclusion and exclusion criteria were applied retrospectively, to a database comprising 4 years of emergency department (ED) cardiac arrests (n=395). This provided estimates of the number of patients who would have qualified for EMS transport for ECPR and initiation of ECPR in the ED. Results: Application of criteria would result in 20.0% (95% CI 16.2-24.3%) of CA being transported to the ED for ECPR (mean 18.5 patients per year). In the ED 4.6% (95% CI 2.83-7.26%) would be eligible to receive ECPR (4.3 patients per year). Incorporating downtime criteria, 3.0% (95% CI 1.6-5.3%) qualify. After considering local in-house cardiac catheterization hours 9.4% (95% CI 6.8-12.9%) and 5.4% (95% CI 3.5-8.2%), without and with EMS rhythm assumptions respectively, would be eligible for transport. For placement on pump, 3.0% (95% CI 1.6-5.3%) and 2.4% (95% CI 1.2-4.6%), without and with use of total downtime respectively, were eligible. Conclusion: If historical patterns of CA were to continue, we believe that an ECPR program may be feasible in our regional hospital setting, with a small number of selected cardiac arrest patients meeting eligibility for transportation and initiation of ECPR. These numbers suggest that an ECPR program would not be resource intensive, yet would be sufficiently busy to maintain adequate team competency.

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Abstract 10336: ECPR 2 : Expert Consensus on PeRcutaneous Cannulation for Extracorporeal CardioPulmonary Resuscitation

Circulation ◽

10.1161/circ.144.suppl_2.10336 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Florian F Schmitzberger ◽

Nathan L Haas ◽

Ryan A Coute ◽

Jason Bartos ◽

Amy E Hackmann ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Best Practices ◽

Delphi Process ◽

Expert Consensus ◽

Snowball Sampling ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Modified Delphi ◽

Expert Opinions ◽

International Panel ◽

Patient Arrival

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged as a promising resuscitation strategy for select patients suffering out-of-hospital cardiac arrest (OHCA), though limited data exists regarding detailed best practices for the complex process of initiating ECPR following OHCA. Hypothesis: Expert consensus using a modified Delphi process can systematically identify detailed best practices for ECPR initiation following adult non-traumatic OHCA. Methods: We utilized a modified Delphi process consisting of two survey rounds and a virtual consensus meeting to systematically identify 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. Results: Snowball sampling generated a panel of 14 content experts, composed of physicians from four continents and four primary specialties. Seven existing institutional protocols for ECPR cannulation following OHCA were identified and merged into a single comprehensive list of 216 items. The panel ultimately reached consensus on 95 items: Prior to Patient Arrival (8 items), Inclusion Criteria (8), Exclusion Criteria (7), Patient Arrival (8), ECPR Cannulation (21), Go On Pump (17), and Post-Cannulation (26). Conclusion: We present a list of essential items for initiation of ECPR following adult non-traumatic OHCA, generated using a modified Delphi process from an international panel of content experts. These findings can benefit centers currently performing ECPR for OHCA in quality assurance and performance improvement, and can serve as a template for new ECPR programs to follow.

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Achieving Consensus on Leadership Competencies and Outcome Measures

Evaluation & the Health Professions ◽

10.1177/0163278705281076 ◽

2005 ◽

Vol 28 (4) ◽

pp. 428-446 ◽

Cited By ~ 7

Author(s):

Julie A. Mcdougal ◽

C. Michael Brooks ◽

Mark Albanese

Keyword(s):

Outcome Measures ◽

Leadership Training ◽

Phase 1 ◽

Nominal Group Technique ◽

Leadership Competencies ◽

Nominal Group ◽

Evaluation Instrument ◽

Modified Delphi ◽

Formal Program ◽

Modified Delphi Technique

Pediatric Pulmonary Centers (PPCs) are federally funded interdisciplinary leadership training programs aiming to improve the health of families and children. This article describes the process PPCs used to efficiently and effectively achieve consensus on leadership training competencies and outcome measures among a large and diverse group of health professionals. Phase 1 used a modified Delphi technique to develop an initial set of competencies and outcome measures. Phase 2 used the nominal group technique and modified focus group strategies to refine and prioritize the competencies and outcomes measures. Participants reported being highly satisfied with the process and outcomes. In Phase 3, a formal program evaluation instrument was implemented, designed to measure the competency and describe the career paths and leadership accomplishments of previous trainees. The consensus process adopted can serve as a model for academic and public health entities seeking to achieve consensus on program goals, strategies, methods, priorities, and outcomes.

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Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Out-of-Hospital Cardiac Arrest due to Pulseless Ventricular Tachycardia/Fibrillation

Journal of Interventional Cardiology ◽

10.1155/2020/6939315 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Konstantinos Dean Boudoulas ◽

Bryan A. Whitson ◽

David P. Keseg ◽

Scott Lilly ◽

Cindy Baker ◽

...

Keyword(s):

Cardiac Arrest ◽

Ventricular Tachycardia ◽

Cardiopulmonary Resuscitation ◽

Medical Center ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Neurologic Recovery ◽

Cardiac Catheterization Laboratory ◽

Number Of Patients ◽

Significant Difference ◽

Hospital Cardiac Arrest

Background. Survival rates for out-of-hospital cardiac arrest are very low and neurologic recovery is poor. Innovative strategies have been developed to improve outcomes. A collaborative extracorporeal cardiopulmonary resuscitation (ECPR) program for out-of-hospital refractory pulseless ventricular tachycardia (VT) and/or ventricular fibrillation (VF) has been developed between The Ohio State University Wexner Medical Center and Columbus Division of Fire. Methods. From August 15, 2017, to June 1, 2019, there were 86 patients that were evaluated in the field for cardiac arrest in which 42 (49%) had refractory pulseless VT and/or VF resulting from different underlying pathologies and were placed on an automated cardiopulmonary resuscitation device; from these 42 patients, 16 (38%) met final inclusion criteria for ECPR and were placed on extracorporeal membrane oxygenation (ECMO) in the cardiac catheterization laboratory (CCL). Results. From the 16 patients who underwent ECPR, 4 (25%) survived to hospital discharge with cerebral perfusion category 1 or 2. Survivors tended to be younger (48.0 ± 16.7 vs. 59.3 ± 12.7 years); however, this difference was not statistically significant (p=0.28) likely due to a small number of patients. Overall, 38% of patients underwent percutaneous coronary intervention (PCI). No significant difference was found between survivors and nonsurvivors in emergency medical services dispatch to CCL arrival time, lactate in CCL, coronary artery disease severity, undergoing PCI, and pre-ECMO PaO2, pH, and hemoglobin. Recovery was seen in different underlying pathologies. Conclusion. ECPR for out-of-hospital refractory VT/VF cardiac arrest demonstrated encouraging outcomes. Younger patients may have a greater chance of survival, perhaps the need to be more aggressive in this subgroup of patients.

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A retrospective analysis of inpatient cardiac arrests over one year at a tertiary heart attack and cardiothoracic centre identifying potential candidates for an inpatient extracorporeal cardiopulmonary resuscitation service

Journal of the Intensive Care Society ◽

10.1177/1751143719848660 ◽

2019 ◽

Vol 21 (2) ◽

pp. 105-110

Author(s):

Suzanne Harrogate ◽

Benjamin Stretch ◽

Rosie Seatter ◽

Simon Finney ◽

Ben Singer

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Case Series ◽

Working Hours ◽

Inclusion Criteria ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Improved Outcomes ◽

Number Of Patients ◽

Cardiac Centre ◽

One Year

Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) is an internationally recognised treatment for refractory cardiac arrest, with evidence of improved outcomes in selected patient groups from cohort studies and case series. In order to establish the clinical need for an in-hospital extracorporeal cardiopulmonary resuscitation service at a tertiary cardiac centre, we analysed the inpatient cardiac arrest database for the previous 12 months. Methods Evidence-based inclusion criteria were used to retrospectively identify the number of patients potentially eligible for extracorporeal cardiopulmonary resuscitation over a 12-month period. Results A total of 261 inpatient cardiac arrests were analysed with 21 potential extracorporeal cardiopulmonary resuscitation candidates meeting the inclusion criteria (1.75 patients per month, or 8% of inpatient cardiac arrests (21/261)). The majority (71%) of these cardiac arrests occurred outside of normal working hours. Survival-to-discharge within this sub-group with conventional cardiopulmonary resuscitation was 19% (4/21). Conclusion Sufficient numbers of refractory inpatient cardiac arrests occur to justify an extracorporeal cardiopulmonary resuscitation service, but a 24-h on-site extracorporeal membrane oxygenation team presents a significant financial and logistical challenge.

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Characterizing spontaneously reported cognitive complaints: the development and reliability of a classification instrument

International Psychogeriatrics ◽

10.1017/s1041610212001494 ◽

2012 ◽

Vol 25 (1) ◽

pp. 157-166 ◽

Cited By ~ 6

Author(s):

Daniel Apolinario ◽

Rafaela Branco Miranda ◽

Claudia Kimie Suemoto ◽

Regina Miksian Magaldi ◽

Alexandre Leopold Busse ◽

...

Keyword(s):

High Reliability ◽

Phase 1 ◽

Observer Agreement ◽

Medical Attention ◽

Cognitive Complaints ◽

Cognitive Difficulties ◽

Modified Delphi ◽

Modified Delphi Technique ◽

Practical Tool ◽

Perceived Cognitive Function

ABSTRACTBackground: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument.Methods: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q).Results: The patients reported 493 spontaneous complaints, with a range of 1–6 complaints per patient and a mean of 2.7 (±1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the κ statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated.Conclusion: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.

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The development of a needs assessment instrument for summer orientation students through the use of a modified Delphi technique

10.31274/rtd-180813-7277 ◽

1988 ◽

Author(s):

Mary Celine Moore

Keyword(s):

Needs Assessment ◽

Delphi Technique ◽

Assessment Instrument ◽

Modified Delphi ◽

Modified Delphi Technique

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Developing an Instrument of Life Balance Factors among Female Engineers who have Family: The Application of Modified Delphi Technique

International Journal of Psychosocial Rehabilitation ◽

10.37200/ijpr/v23i4/pr190424 ◽

2019 ◽

Vol 23 (4) ◽

pp. 966-972

Author(s):

Ummu Sakinah Subri ◽

Ridzwan Che Rus ◽

Ramlee Mustapha ◽

Zaliza Hanapi

Keyword(s):

Delphi Technique ◽

Life Balance ◽

Modified Delphi ◽

Modified Delphi Technique

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Using In-Situ Simulation for Extracorporeal Cardiopulmonary Resuscitation (ECPR) Guideline Development.

SSRN Electronic Journal ◽

10.2139/ssrn.3409806 ◽

2019 ◽

Cited By ~ 1

Author(s):

Paul Ross ◽

Chris Nickson ◽

Jayne Sheldrake ◽

Jason McClure

Keyword(s):

Cardiopulmonary Resuscitation ◽

Guideline Development ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

In Situ Simulation

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The Hospice Farewell: Ideological Perspectives of its Professional Practitioners

OMEGA - Journal of Death and Dying ◽

10.2190/63tk-bmhx-lmur-1e1m ◽

1990 ◽

Vol 21 (4) ◽

pp. 283-300 ◽

Cited By ~ 9

Author(s):

Anoel Rinaldi ◽

Michael C. Kearl

Keyword(s):

Hospice Care ◽

National Sample ◽

High Rate ◽

Older Individuals ◽

Modified Delphi ◽

Death Denial ◽

Cultural Climate ◽

Quality Of Death ◽

Modified Delphi Technique ◽

Professional Practitioners

This research examines a social service devoted to “good deaths” in our country: hospice. Using a modified Delphi technique, a national sample of hospice experts ( n = 48) was questioned in order to elicit group judgments about hospice ideology, the issue of control over one's own death trajectory, and hospice's relevance for older individuals. The respondents generally concurred that hospice, influenced by the work of Kübler-Ross, represents a radical departure in how we die, a reaction to the quality of death within a cultural climate of death denial, and, in some sense, a demodernization movement. While a high rate of consensus was obtained on many of the issues that evolved, little evidence of a coherent ideology could be detected linking notions of hospice origins, issues of patient control, and suitability of hospice care for older individuals.

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