Mark Dennis, A. Supady, Darryl Abrams, Jason A. Bartos, Jae Seung Jung, Natalie Kruit, Steven Kin-ho Ling, Alex Rosenberg, Mark Sackley, Tommaso Scquizzato, A. Burrell, Marta Velia Antonini, Eduard Argudo, Jan Bělohlávek, Yih‐Sharng Chen, Sung Min Cho, Genex Correa, Dirk Donker, Vadim Gudzenko, Toru Hifumi, Shingo Ichiba, Akihiko Inoue, Jan Matthias Kruse, Keibun Liu, Roberto Lorruso, Jonathan Marinaro, Christian Meuwese, Dinis Dos Reis Miranda, Hiromichi Naito, Nchafatso Obonyo, Yohei Okada, Marcel Van de Poll, Michael Poppe, Carla Richardson, Sacha Richardson, Claudio Sandroni, Mara Scandroglio, Zachary Shinar, Ben Singer, Justyna Swol, Fabio Taccone, Joseph Tonna, Georg Trummer, Charudatt Vaity, Leen Vercaemst, Melissa A. Vogelsong, Chih‐Hsien Wang, Ryo Yamamoto, Shoji Yokobori, Bishoy Zakhary, Alejandra Gutierrez Bernal, Adam L. Gottula, Jeff Dellavolpe, Andrea Elliot, Demetris Yannopolous, Naofumi Bunya, Clara Hernandez Caballero, Ana Sofia Dacostapinto, Alexander Dietl, Thomas Muller, Alice Hutin, Lionel Lamhaut, Scott D. Weingart
BACKGROUND: The global adoption of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest is accelerating, reflecting its potential to improve outcomes in select patient populations. Although research has increasingly focused on patient selection criteria, there remains a critical lack of evidence to guide best practices in post-ECPR resuscitation management. This study aimed to identify key knowledge gaps and develop consensus-based recommendations to inform clinical decision-making in the post-ECPR setting. METHODS: An international, multidisciplinary steering committee comprising 11 ECPR experts and 1 survivor conducted a targeted literature review to identify key domains and gaps in post-ECPR care. Experts were recruited based on field impact and snowball sampling. A modified Delphi process was used, comprising 3 survey rounds. Consensus was defined a priori as ≥70% agreement or disagreement on Likert-scale statements. RESULTS: A total of 53 experts were recruited, representing diverse health care professions, gender, and levels of clinical experience. Of these, 52 (98%) completed all 3 rounds of the Delphi process. Consensus was reached on 126 individual statements, which were synthesized into 42 summary position statements. These recommendations span key domains of post-ECPR care, including system-level considerations, hemodynamic targets and management strategies, ventilation and oxygenation protocols, anticoagulation practices, temperature regulation, complication mitigation, weaning approaches, and neuroprognostication. CONCLUSIONS: This modified Delphi study, informed by a diverse international panel, resulted in 42 consensus-based position statements addressing key aspects of post-ECPR care. In the absence of robust empirical evidence, these expert-derived recommendations offer a valuable framework to support clinical decision-making and the development of standardized post-ECPR resuscitation protocols. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06552312.