Table 1.
Priority topics and corresponding PICOs
| No. | Topic | Population | Intervention | Control | Outcome | Sub-topics |
|---|---|---|---|---|---|---|
| 1 | Cardiogenic shock: definition, degree and timing of cardiogenic shock as VA-ECMO indication | Patients suffering cardiogenic shock1 | Early in course | Refractory cardiogenic shock | Shock reversal, in-hospital mortality | – |
| 2 | Selection criteria for ECPR | Patients suffering cardiac arrest | ECPR (VA-ECMO) | Conventional cardiopulmonary resuscitation | In-hospital mortality, length-of-stay |
Patient age Time-to-ECMO Location of insertion: in-hospital/on-site |
| 3 | ECMO connecting: percutaneous versus surgical methods | Patients undergoing cannulation for VA-ECMO | Percutaneous cannulation | Surgical cannulation | Hemorrhage, in-hospital mortality | – |
| 4 | Monitoring: daily therapy goals | Patients supported with VA-ECMO | Daily goals | Standard care | In-hospital mortality |
Fluid balance, min/max Reducing blood flow Reducing sedatives |
| 5 | Monitoring: optimal balance of blood pressure & vasoactive medication | Patients supported with VA-ECMO | Accepting a lower MAP (< 65 mmHg) | Standard MAP (≥ 65 mmHg) | In-hospital mortality | – |
| 6 | Blood transfusion regimen | Patients supported with VA-ECMO | Restrictive regimen (dependent of blood product) | Liberal regimen (dependent of blood product) | In-hospital mortality |
Red blood cells Platelets Plasma |
| 7 | Anticoagulant therapies | Patients supported with VA-ECMO | Non-heparin anticoagulant therapy | Continuous systemic heparin | In-hospital mortality |
LMWH Bivalirudin DTIs |
| 8 | Complications: endothelial activation and damage | Patients supported with VA-ECMO | Monitoring endothelial damage and activation markers | No additional markers/monitoring | In-hospital mortality |
ICAM-1 VCAM Syndecam-1 |
DTI direct thrombin inhibitors, ICAM-1 intercellular adhesion molecule 1, MAP mean arterial pressure, ROSC return of spontaneous circulation, VA-ECMO veno-arterial extracorporeal membrane oxygenation, VCAM vascular cell adhesion molecule
1Defining early in course and refractory as INTERMACS level 2 (“sliding on inotropes”) and level 1 (“crash and burn”), respectively