Publication Date
7-1-2024
Journal
Pediatric Critical Care Medicine
DOI
10.1097/PCC.0000000000003490
PMID
38959360
PMCID
PMC11216378
PubMedCentral® Posted Date
7-3-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Humans, Extracorporeal Membrane Oxygenation, Anticoagulants, Child, Delphi Technique, Perioperative Period, Consensus, Perioperative Care, Hemorrhage, Thrombosis, antifibrinolytics, blood transfusions, extracorporeal membrane oxygenation, hemostatic agents, pediatrics, perioperative procedures anticoagulation
Abstract
OBJECTIVES: To derive systematic review-informed, modified Delphi consensus regarding the management of children on extracorporeal membrane oxygenation (ECMO) undergoing invasive procedures or interventions developed by the Pediatric Anticoagulation on ECMO CollaborativE (PEACE) Consensus Conference.
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.
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