UK consensus statement on priorities to support the process of withdrawal of veno-venous extracorporeal membrane oxygenation.

Abstract

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. The study aimed to establish consensus-based priorities for management of the process of VV-ECMO withdrawal to reduce practice variability and improve care quality. 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. 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 seven UK ECMO centres considered eight as essential, six desirable, one not required; one 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. 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 a developmental step towards a standardised approach to support patients, family members, and clinicians through this challenging clinical situation.