Management of Extracorporeal Membrane Oxygenation Anticoagulation in the Perioperative Period: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.
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Willems Ariane, Anders Marc M, Garcia Alejandro V, Vogel Adam M, Yates Andrew R, Muszynski Jennifer A, Alexander Peta M A, Steffen Katherine, Emani Sitaram, Gehred Alison, Lyman Elizabeth, Raman Lakshmi, Pediatric Extracorporeal Membrane Oxygenation [ECMO] Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)
Аннотация
DATA SOURCES: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.
STUDY SELECTION: ECMO anticoagulation and hemostasis management in the perioperative period and during procedures.
DATA EXTRACTION: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Seventeen references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.
DATA SYNTHESIS: Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. Four good practice statements, 7 recommendations, and 18 consensus statements are presented.
CONCLUSIONS: Although agreement among experts was strong, important future research is required in this population for evidence-informed recommendations.