# Protocol for the development of NHMRC-endorsed guidelines for extracorporeal membrane oxygenation using GRADE methodology

## TL;DR

This paper outlines a process for creating evidence-based guidelines for ECMO use in Australia and New Zealand using GRADE methodology.

## Contribution

A detailed protocol for developing NHMRC-endorsed ECMO guidelines using GRADE methodology in the Australian and New Zealand context.

## Key findings

- The protocol outlines a three-phase approach to analyze available evidence on ECMO.
- GRADEpro and Covidence software will be used for systematic review and guideline development.
- Guidelines will be published in peer-reviewed journals and accessible via the GRADEpro GDT application.

## Abstract

The last 15 years have seen a rapid expansion in the use of extracorporeal life support. ECMO has evolved from a rescue treatment available in a few expert centres to an organ support modality for many forms of severe respiratory or cardiovascular failure. There is currently wide variation around the indications for, management of, and systems to support the practice of ECMO. There are few available guidelines on this topic; most have limitations and are not readily generalisable to the Australian or New Zealand healthcare systems.

This article aims to describe the processes that will be used to produce evidence-based guidelines on the use of ECMO in Australia and New Zealand. The protocol is informed by the National Health and Medical Research Council (NHMRC) Guidelines for Guidelines, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.

Analysis of available evidence on the identified questions follows a three-phase approach. Firstly, published guidelines will be identified and an assessment of their relevance, methodology and validity carried out. If there are no guidelines on the topic, the second step involves a search and evaluation of systematic reviews. Lastly, a de-novo systematic analysis of primary literature will be undertaken where no systematic reviews are available. The development process will be conducted using the GRADEpro and Covidence software for de novo systematic reviews.

The guideline will be published in peer-reviewed journals and summaries will be provided to end-users via the GRADEpro GDT application.