Traditional Poster Round
Context: : Extracorporeal membrane oxygenation (ECMO) is a low-volume, high-risk modality of care whose management requires quick and decisive application of knowledge. Clinical specialists (CS) who manage ECMO circuit emergencies vary in background and approach to circuit emergencies based on institutional training standards, leading to variation that may impact the quality of care. Validated checklists to assess CS performance and competency in a simulated environment are crucial to eliminate disparities and improve efficiency. This study focused on the development and validation of checklists to evaluate the clinical performance of ECMO CS in three ECMO circuit emergencies.
Description: : A research team with diverse clinical and professional background from our institution developed the first iteration of three ECMO emergency checklists to address; (1) venous air, (2) arterial air and (3) oxygenator failure. An iterative, modified Delphi technique utilizing a national panel of ECMO content experts was used to develop content validity evidence for the three checklists. Versions of each checklist were sent to the expert panel with steps proposed for responding to each ECMO emergency. Rating scales from 1 to 7, labeled as 1 to 3 (not important), 4 to 6 (important), and 7 (mandatory) were used to evaluate each checklist item. With each round of Delphi our experts would rate each step based on importance with unimportant steps being thrown out and those that remained edited based on comments from our expert panel. Outcome measures include the mean rating of importance by the experts for each checklist item and the agreement among experts as calculated by Cronbach’s alpha.
Observation/Evaluation: : A panel of 11 ECMO experts was recruited for 3 rounds of Delphi. The response rate for each round was 100%. Items with mean score >4 were kept and revised, and new item recommendations were added based on comments from the expert panel. The venous air, arterial air and oxygenator failure checklists were revised from 10, 13, and 9 items to 12, 12 and 10 items respectively. All items kept in the final checklists had a mean rating of 6.68 out of 7. A Cronbach’s α of 0.74 was calculated using the second round of responses, indicating an acceptable degree of agreement.
Discussion: : Our team utilized the Delphi technique among a group of national ECMO experts to create three checklists for responding to ECMO emergencies. In future work we will utilize these checklists to assess ECMO clinical specialist in a simulated environment. These checklists and those developed in the future could serve as a simulation training standards at our institutions worldwide.