Anticoagulant Medications: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.

To derive systematic-review informed, modified Delphi consensus regarding the medications used for anticoagulation for pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE (PEACE). A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. Included studies assessed anticoagulation used in pediatric ECMO. Two authors reviewed all citations independently, with a third reviewer adjudicating any conflicts. Eighteen references were used for data extraction as well as for creation of recommendations. Evidence tables were constructed using a standardized data extraction form. 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-informed recommendations and, when evidence was lacking, expert-based consensus statements, or good practice statements for anticoagulation during pediatric ECMO. A web-based modified Delphi process was used to build consensus via the Research and Development/University of California Appropriateness Method. Consensus was based on a modified Delphi process with agreement defined as greater than 80%. Two recommendations, two consensus statements, and one good practice statement were developed, and, in all, agreement greater than 80% was reached. There is insufficient evidence to formulate optimal anticoagulation therapy during pediatric ECMO. Additional high-quality research is needed to inform evidence-based practice for anticoagulation during pediatric ECMO.

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Déclaration de conflit d'intérêts

The Executive Committee (Drs. Alexander, Muszynski, Bembea, Cheifetz, Steiner, and Barbaro) served as arbitrators for conflict of interest management. Dr. Alexander’s institution received funding from Novartis (ProspectiveTrial to Assess the Angiotensin Receptor Blocker Neprilysin Inhibitor LCZ696 Versus Angiotensin-Converting Enzyme Inhibitor for the Medical Treatment of Pediatric HF [PANORAMA-HF]). Dr. Sloan commenced employment with CSL Behring after the consensus process was complete. Dr. Patregnani discloses consultation payments from MNK Pharmaceuticals and Pfizer. Dr. Dalton discloses she is a consultant for Innovative Extracorporeal Membrane Oxygenation Concepts, Hemocue Entegrion, and Medtronic. Dr. Ryerson received an honorarium from the Instrumentation Laboratory for consultation work. Drs. Brandão, Monagle, Ryerson, Alexander, and Dalton disclosed the off-label product use of direct thrombin inhibitors for pediatric ECMO anticoagulation. Dr. Muszynski’s institution received funding from the National Institutes of Health (NIH). Drs. Muszynski and Alexander received support for article research from the NIH. Dr. Alexander’s institution received funding from the National Institute of Child Health and Human Development (R13HD104432), ELSO, and Novartis. Dr. Dalton received funding from Innovative ECMO Concepts, Entegrion, and Hemocue. The remaining authors have disclosed that they do not have any potential conflicts of interest.