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either a sterile saline or heparinized flush based on clinical in- Disclosures
dication and mediation availability (items 19 and 27). Finally, The authors have no financial conflicts of interest to disclose.
consideration of systemic heparinization was moved after wire
placement and before dilation and cannula placement to en- References
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Importance of Checklists in Training and Validation rial carbon dioxide levels caused by extracorporeal membrane
The development of a bifemoral VV ECMO cannulation oxygenation. The temptation of a fascinating technology. Am J
checklist that can be used in the operational environment is Respir Crit Care Med. 2020;201(12):1466–1468. doi:10.1164/
important. First, this checklist provides an initial framework rccm.202004-1060ED.
for the development of training platforms for advanced medi- 3. Schmidt M, Pellegrino V, Combes A, Scheinkestel C, Cooper
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training of advanced medical teams may improve procedural 6. Powell MEK, Reynolds TS, Webb JK, et al. Early veno-venous
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would create by choosing experts with extracorporeal support safety outcomes: a systematic review of randomized controlled tri-
procedural knowledge and operational experience and inter- als. J Hosp Med. 2017;12(8):675–682. doi:10.12788/jhm.2788.
est. In addition, our checklist includes ultrasound guidance for 10. Kunz D, Pariyadath M, Wittler M, Askew K, Manthey D, Hartman
both placement of cannulas and confirmation of positioning. N. Derivation of a performance checklist for ultrasound-guided
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Checklists are used in training and to optimize procedure tech- nulation technique: femoro-femoral. J Thorac Dis. 2018;10(Suppl
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studies on the use of the checklist and patient outcomes are and reporting the Delphi method for selecting healthcare quality
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required. doi:10.1371/journal.pone.0020476.
15. Baez J, Powell E, Leo M, Stolz U, Stolz L. Derivation of a pro-
Author Contributions cedural performance checklist for ultrasound-guided femoral ar-
EP performed study design, data collection, and manuscript terial line placement using the modified Delphi method. J Vasc
de velopment. RB performed concept development and man- Access. 2020;21(5):715–722. doi:10.1177/1129729820904872.
uscript editing. RK performed concept development and 16. Eubank BH, Mohtadi NG, Lafave MR, et al. Using the modified
Delphi method to establish clinical consensus for the diagnosis
provided expert review. DH performed expert review. MK per- and treatment of patients with rotator cuff pathology. BMC Med
formed data collection and expert review. SG performed con- Res Methodol. 2016;16:56. doi:10.1186/s12874-016-0165-8.
cept development, data analysis, and manuscript revision. 17. Napp LC, Kuhn C, Hoeper MM, et al. Cannulation strategies for
percutaneous extracorporeal membrane oxygenation in adults.
Disclaimer Clin Res Cardiol. 2016;105(4):283–296. doi:10.1007/s00392-
No funding was used for this work. 015-0941-1.

36 | JSOM Volume 23, Edition 1 / Spring 2024