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

Circulation ◽  
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.

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

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S101-S101
Author(s):  
D. Rollo ◽  
P. Atkinson ◽  
J. Fraser ◽  
J. Mekwan ◽  
J. P. French ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Phase 1 ◽  
Hospital Setting ◽  
Regional Hospital ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Modified Delphi ◽  
Phase Study ◽  
Number Of Patients ◽  
Modified Delphi Technique ◽  
Poor Outcomes

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.

scholarly journals Patterns of Success for Urban 4-H Youth Development in the Near Future

2007 ◽  
Vol 2 (2) ◽  
pp. 74-90
Author(s):  
W. Jack Kerrigan, Jr.
Keyword(s):  
Best Practices ◽  
Youth Development ◽  
Delphi Study ◽  
Qualitative Data ◽  
Delphi Process ◽  
Delphi Panel ◽  
Target Populations ◽  
Modified Delphi ◽  
Development Programming ◽  
Near Future

A Modified Delphi study identified patterns of success for urban Extension 4-H programming in the next five years. The Delphi panel of 20 experts represented all regions, program areas, organizational levels as well as two external friends of Extension. The Delphi process provided both quantitative and qualitative data on the topics of collaboration, target populations, and programming. Fifteen patterns of success were identified for urban 4-H youth development. These patterns should serve as best practices for Extension youth development programming in urban counties for “making the best better!” in the near future.

scholarly journals Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process

2019 ◽  
Vol 33 (4) ◽  
Author(s):  
M Konradsson ◽  
M I van Berge Henegouwen ◽  
C Bruns ◽  
M A Chaudry ◽  
E Cheong ◽  
...  
Keyword(s):  
Diagnostic Criteria ◽  
Gastric Conduit ◽  
Delphi Process ◽  
Adverse Outcomes ◽  
Water Soluble ◽  
Expert Consensus ◽  
Barium Swallow ◽  
International Expert ◽  
Modified Delphi ◽  
Esophagectomy For Cancer

Abstract Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: >500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or >100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air–fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have ‘quite a bit’ or ‘very much’ of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: ‘not at all’, ‘a little’, ‘quite a bit’, or ‘very much’, generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process.

Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

2006 ◽  
Vol 67 (S1) ◽  
pp. S14-S29 ◽  
Author(s):  
Paula Brauer ◽  
Linda Dietrich ◽  
Bridget Davidson ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Administrative Support ◽  
Care Service ◽  
Delphi Process ◽  
Care Providers ◽  
Modified Delphi ◽  
Nutrition Services ◽  
Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021

2021 ◽  
pp. 1-10
Author(s):  
Christopher Gaisendrees ◽  
Matias Vollmer ◽  
Sebastian G Walter ◽  
Ilija Djordjevic ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Identifying the capabilities most important for veterinary employability using a modified Delphi process

2021 ◽  
Author(s):  
Melinda A. Bell ◽  
Martin A. Cake ◽  
Laura T. King ◽  
Caroline F. Mansfield
Keyword(s):  
Delphi Process ◽  
Modified Delphi
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