Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Author:

Muszynski Jennifer A.1,Bembea Melania M.2,Gehred Alison3,Lyman Elizabeth3,Cashen Katherine4,Cheifetz Ira M.5,Dalton Heidi J.6,Himebauch Adam S.7,Karam Oliver89,Moynihan Katie M.101112,Nellis Marianne E.13,Ozment Caroline14,Raman Lakshmi15,Rintoul Natalie E.16,Said Ahmed17,Saini Arun18,Steiner Marie E.19,Thiagarajan Ravi R.1011,Watt Kevin20,Willems Ariane21,Zantek Nicole D.22,Barbaro Ryan P.23,Steffen Katherine24,Vogel Adam M.25,Alexander Peta M.A.1011,

Affiliation:

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

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

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

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

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

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

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

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

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

10. Department of Cardiology, Boston Children’s Hospital, Boston, MA.

11. Department of Pediatrics, Harvard Medical School, Boston, MA.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Abstract

OBJECTIVES: To identify and prioritize research questions for anticoagulation and hemostasis management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus. DATA SOURCES: Systematic review was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial consensus conferences of international, interprofessional experts in the management of ECMO for critically ill neonates and children. STUDY SELECTION: The management of ECMO anticoagulation for critically ill neonates and children. DATA EXTRACTION: Within each of the eight subgroups, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. DATA SYNTHESIS: Following the systematic review of MEDLINE, EMBASE, and Cochrane Library databases from January 1988 to May 2021, and the consensus process for clinical recommendations and consensus statements, PEACE panel experts constructed research priorities using the Child Health and Nutrition Research Initiative methodology. Twenty research topics were prioritized, falling within five domains (definitions and outcomes, therapeutics, anticoagulant monitoring, protocolized management, and impact of the ECMO circuit and its components on hemostasis). CONCLUSIONS: We present the research priorities identified by the PEACE expert panel after a systematic review of existing evidence informing clinical care of neonates and children managed with ECMO. More research is required within the five identified domains to ultimately inform and improve the care of this vulnerable population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference71 articles.

1. Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation.;Dalton;Am J Respir Crit Care Med,2017

2. 2021 ELSO adult and pediatric anticoagulation guidelines.;McMichael;ASAIO J,2022

3. 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 the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO): Executive summary: Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.;Alexander;Pediatr Crit Care Med,2024

4. Ongoing variability in pediatric extracorporeal membrane oxygenation anticoagulation practices—could consensus change the next survey results?;Alexander;Pediatr Crit Care Med,2021

5. 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 the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO): The influence of the extracorporeal membrane oxygenation circuit and components on anticoagulation management: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE consensus conference.;Himebauch;Pediatr Crit Care Med,2024

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