Executive Summary: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE) Consensus Conference*

Author:

Alexander Peta M. A.1,Bembea Melania M.2,Cashen Katherine3,Cheifetz Ira M.4,Dalton Heidi J.5,Himebauch Adam S.6,Karam Oliver78,Moynihan Katie M.19,Nellis Marianne E.10,Ozment Caroline11,Raman Lakshmi12,Rintoul Natalie E.13,Said Ahmed S.14,Saini Arun15,Steiner Marie E.16,Thiagarajan Ravi R.1,Watt Kevin17,Willems Ariane18,Zantek Nicole D.19,Barbaro Ryan P.20,Steffen Katherine21,Vogel Adam M.22,Almond Christopher23,Anders Marc M.15,Annich Gail M.24,Brandão Leonardo R.25,Chandler Wayne26,Delaney Megan2728,DiGeronimo Robert29,Emani Sitaram30,Gadepalli Samir K.31,Garcia Alejandro V.32,Haileselassie Bereketeab21,Hyslop Robert33,Kneyber Martin C. J.34,Baumann Kreuziger Lisa35,Le Jennifer36,Loftis Laura15,McMichael Ali B. V.1237,McMullan D. Michael38,Monagle Paul39,Nicol Kathleen40,Paden Matthew L.41,Patregnani Jason42,Priest John43,Raffini Leslie44,Ryerson Lindsay M.45,Sloan Steven R.4647,Teruya Jun48,Yates Andrew R.49,Gehred Alison50,Lyman Elizabeth50,Muszynski Jennifer A.51,

Affiliation:

1. Department of Cardiology, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA.

2. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

3. Department of Pediatrics, Duke Children’s Hospital, Duke University, Durham, NC.

4. Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.

5. Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA.

6. Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

7. Division of Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA.

8. Division of Critical Care Medicine, Yale School of Medicine, New Haven, CT.

9. Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

10. Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell, New York, NY.

11. Division of Critical Care Medicine, Department of Pediatrics, Duke University and Duke University Health System, Durham, NC.

12. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.

13. Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

14. Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.

15. Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX.

16. Department of Pediatrics, Divisions of Hematology and Critical Care, University of Minnesota, Minneapolis, MN.

17. Division of Clinical Pharmacology, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

18. Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.

19. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.

20. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

21. Department of Pediatrics (Pediatric Critical Care Medicine), Stanford University, Palo Alto, CA.

22. Departments of Surgery and Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX.

23. Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA.

24. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.

25. Department of Pediatrics, The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

26. Department of Laboratories, Seattle Children’s Hospital, Seattle, WA.

27. Division of Pathology and Lab Medicine and Transfusion Medicine, Children’s National Hospital, Washington, DC.

28. Departments of Pathology and Pediatrics, The George Washington University Health Sciences, Washington, DC.

29. Department of Pediatrics, Division of Neonatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA.

30. Department of Cardiovascular Surgery, Boston Children’s Hospital, and Department of Surgery, Harvard Medical School, Boston, MA.

31. Division of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI.

32. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

33. Heart Institute, Children’s Hospital of Colorado, Aurora, CO.

34. Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

35. Versiti Blood Research Institute and Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI.

36. Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA.

37. Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ.

38. Division of Pediatric Cardiac Surgery, Seattle Children’s Hospital, Seattle, WA.

39. University of Melbourne, and Kids Cancer Centre Sydney Children’s Hospital, and Murdoch Children’s Research Institute, and Royal Children’s Hospital Melbourne Australia, Melbourne, VIC, Australia.

40. Department of Pathology, Nationwide Children’s Hospital, Columbus, OH.

41. Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.

42. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Barbara Bush Children’s Hospital, Portland, ME.

43. Department of Respiratory Care, Boston Children’s Hospital, Boston MA.

44. Department of Pediatrics, Division of Hematology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.

45. Department of Pediatrics, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada.

46. Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA.

47. CSL Behring, King of Prussia, PA.

48. Division of Transfusion Medicine and Coagulation, Texas Children’s Hospital and Baylor College of Medicine, Houston, TX.

49. Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Nationwide Children’s Hospital and the Ohio State University College of Medicine, Columbus, OH.

50. Grant Morrow III MD Medical Library, Nationwide Children’s Hospital Columbus, Columbus, OH.

51. Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children’s Hospital and The Ohio State University of Medicine, Columbus, OH.

Abstract

OBJECTIVES: To present recommendations and consensus statements with supporting literature for the clinical management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus conference. DATA SOURCES: Systematic review was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial meetings of international, interprofessional experts in the management ECMO for critically ill children. STUDY SELECTION: The management of ECMO anticoagulation for critically ill children. DATA EXTRACTION: Within each of eight subgroup, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. DATA SYNTHESIS: A systematic review was conducted using MEDLINE, Embase, and Cochrane Library databases, from January 1988 to May 2021. Each panel developed evidence-based and, when evidence was insufficient, expert-based statements for the clinical management of anticoagulation for children supported with ECMO. These statements were reviewed and ratified by 48 PEACE experts. Consensus was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 23 recommendations, 52 expert consensus statements, and 16 good practice statements covering the management of ECMO anticoagulation in three broad categories: general care and monitoring; perioperative care; and nonprocedural bleeding or thrombosis. Gaps in knowledge and research priorities were identified, along with three research focused good practice statements. CONCLUSIONS: The 91 statements focused on clinical care will form the basis for standardization and future clinical trials.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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