Recommendations on Monitoring and Replacement of Antithrombin, Fibrinogen, and Von Willebrand Factor in Pediatric Patients on Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Authors

Nicole D Zantek
Marie E Steiner
Jun Teruya
Lisa Baumann Kreuziger
Leslie Raffini
Jennifer A Muszynski
Peta M A Alexander
Alison Gehred
Elizabeth Lyman
Kevin Watt

Publication Date

7-1-2024

Journal

Pediatric Critical Care Medicine

DOI

10.1097/PCC.0000000000003492

PMID

38959358

PMCID

PMC11216379

PubMedCentral® Posted Date

7-3-2024

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Extracorporeal Membrane Oxygenation, Humans, Fibrinogen, Antithrombins, Child, von Willebrand Factor, Delphi Technique, Anticoagulants, anticoagulants, antithrombin von Willebrand factor, extracorporeal membrane oxygenation, pediatrics

Abstract

OBJECTIVES: To derive systematic review informed, modified Delphi consensus regarding monitoring and replacement of specific coagulation factors during pediatric extracorporeal membrane oxygenation (ECMO) support for the Pediatric ECMO Anticoagulation CollaborativE.

DATA SOURCES: A structured literature search was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2020, with an update in May 2021.

STUDY SELECTION: Included studies assessed monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric ECMO support.

DATA EXTRACTION: Two authors reviewed all citations independently, with conflicts resolved by a third reviewer if required. Twenty-nine 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. A panel of 48 experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements. 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. We developed one weak recommendation and four expert consensus statements.

CONCLUSIONS: There is insufficient evidence to formulate recommendations on monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric patients on ECMO. Optimal monitoring and parameters for replacement of key hemostasis parameters is largely unknown.