A UK consensus on priorities to support the withdrawal process of veno-venous extra corporeal membrane support (VV-ECMO)

Introduction<br/>Patients with acute severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) have high mortality risk. Management of the process of VV-ECMO withdrawal is challenging, especially in awake patients. Yet there is no guidance to guide clinicians to manage these morally distressing and ethically ambiguous decisions. <br/><br/>Objective<br/>To establish consensus-based priorities for management of the process of VV-ECMO withdrawal to reduce practice variability and improve care quality.<br/><br/>Methods<br/>Our process for generating priority statements for consideration at our consensus meeting included semi-structured interviews and a scoping review. We recruited healthcare professionals with experience in VV-ECMO withdrawal to participate in interviews and a consensus meeting led by an independent facilitator. Using modified nominal group technique, participants discussed and voted on statements, categorising them as essential, desirable, or not required. A subsequent voting round identified key priorities for future research.<br/><br/>Results<br/>During our item generation process we interviewed 12 healthcare professionals with VV-ECMO expertise and identified 41 publications (21 empiric studies and 20 opinion pieces) focused on ECMO withdrawal. We developed 16 priority statements from this data, of which 17 participants representing 7 UK ECMO centres considered 8 as essential, 6 desirable, 1 not required; 1 was without consensus. Areas for future research highlighted were developing a standardised framework for managing disagreements; creating tools to enhance communication and documentation of information provided; and designing quality improvement strategies to ensure consistency in the clinical and technical aspects of VV-ECMO withdrawal.<br/><br/>Conclusion<br/>Using rigorous methods, we have established consensus on eight essential and six desirable priorities for management of VV-ECMO withdrawal and three future research priorities. These consensus-based priorities should be viewed as an developmental step towards a standardised approach to support patients, family members and clinicians through this challenging clinical situation.<br/>