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Development of Validated Checklists to Evaluate Clinical Specialists in Pediatric ECMO Emergencies Using Delphi Method

Abulebda, Kamal*; Hocutt, Gail R.N.C.; Gray, Brian W.; Ahmed, Rami A.§; Slaven, James E.#; Malin, Stefan; Wetzel, Elizabeth A.; Medsker, Brock H.; Byrne, Bobbi J.

doi: 10.1097/MAT.0000000000000988
Original Article: PDF Only
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Extracorporeal membrane oxygenation (ECMO) is a low-volume, high-risk modality of care. 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 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. A research team with diverse clinical background from our institution developed the first iteration of three ECMO emergency checklists: (1) venous air, (2) arterial air, and (3) oxygenator failure. A modified Delphi technique with a panel of 11 national content experts in ECMO was used to develop content validity evidence. Rating scales from 1 to 7 were used to evaluate each checklist item. The response rate for three rounds of Delphi was 100%. Items with mean score >4 were kept, and new item recommendations were added based on comments from the 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. A Cronbach’s α of 0.74 during the second round of responses indicated an acceptable degree of agreement. This study demonstrated content validation of three ECMO emergency checklists to assess performance of ECMO CS using a consensus-based Delphi technique. Future validity evidence should be acquired by implementing these checklists in the simulation environments.

*Department of Pediatrics, Division of Pediatric Critical Care Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana;

ECMO Program Manager, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana;

Division of Pediatric Surgery, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, Indiana;

§Department of Emergency Medicine, Indiana University School of Medicine at Indiana University Health, Indianapolis, Indiana;

Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;

Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana; and

#Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.

Submitted for consideration November 2018; accepted for publication in revised form February 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Kamal Abulebda, Gail R.N.C. Hocutt, Brian W. Gray, Elizabeth A. Wetzel, Bobbi J. Byrne were the leaders of this project and were involved in the conception and design of the project, reviewing the available pertinent literature, data collection, drafting the initial draft of the article, and final approval of the article. Brock H. Medsker, Stefan Malin, Rami A. Ahmed, James E. Slaven were involved in the conception and design of the project, met regularly with the project leader to review preliminary data, analyzed the data, performed critical revisions of the article, and granted final approval of the article.

Data from the study were presented at the 28th Annual ELSO Conference, Scottsdale, AZ 2018.

Correspondence: Kamal Abulebda, Assistant Professor of Clinical Pediatrics, Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at IU Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN 46202-5225. Email: kabulebd@iu.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs