Prophylactic Transfusion Strategies in Children Supported by Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.
Journal
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
01 Jul 2024
01 Jul 2024
Historique:
medline:
3
7
2024
pubmed:
3
7
2024
entrez:
3
7
2024
Statut:
ppublish
Résumé
To derive systematic-review informed, modified Delphi consensus regarding prophylactic transfusions in neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE. 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. Included studies assessed use of prophylactic blood product transfusion in pediatric ECMO. Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Thirty-three references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form. 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 prophylactic transfusion strategies for children supported with 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%. We developed two good practice statements, 4 weak recommendations, and three expert consensus statements. Despite the frequency with which pediatric ECMO patients are transfused, there is insufficient evidence to formulate evidence-based prophylactic transfusion strategies.
Identifiants
pubmed: 38959357
doi: 10.1097/PCC.0000000000003493
pii: 00130478-202407001-00004
doi:
Types de publication
Journal Article
Systematic Review
Consensus Development Conference
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25-e34Informations 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 (consultant on the end-point adjudication committee for Prospective Trial to Assess the Angiotensin Receptor Blocker Neprilysin Inhibitor LCZ696 Versus Angiotensin-Converting Enzyme Inhibitor for the Medical Treatment of Pediatric HF [PANORAMA-HF] clinical trial). Dr. Sloan commenced employment with CSL Behring after the consensus process was complete. Dr. Kneyber received funding from Metran. Drs. Alexander and Muszynski’s institutions received funding from the National Institutes of Health (NIH); they received support for article research from the NIH. Dr. Alexander’s institution received funding from the Extracorporeal Life Support Organization and Novartis. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Besser MW, Klein AA: The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci. 2010; 47:197–212
Reynolds MM, Annich GM: The artificial endothelium. Organogenesis. 2011; 7:42–49
O’Halloran CP, Andren KG, Mecklosky J, et al.: Mortality and factors associated with hemorrhage during pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2020; 21:75–81
Muszynski JA, Reeder RW, Hall MW, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN): RBC transfusion practice in pediatric extracorporeal membrane oxygenation support. Crit Care Med. 2018; 46:e552–e559
Dalton HJ, Reeder R, Garcia-Filion P, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2017; 196:762–771
Karam O, Goel R, Dalton H, et al.: Epidemiology of hemostatic transfusions in children supported by extracorporeal membrane oxygenation. Crit Care Med. 2020; 48:e698–e705
Nellis ME, Vasovic LV, Goel R, et al.: Epidemiology of the use of hemostatic agents in children supported by extracorporeal membrane oxygenation: A pediatric health information system database study. Front Pediatr. 2021; 9:673613
O’Halloran CP, Alexander PMA, Andren KG, et al.: RBC exposure in pediatric extracorporeal membrane oxygenation: Epidemiology and factors associated with large blood transfusion volume. Pediatr Crit Care Med. 2018; 19:767–774
Muszynski JA, Spinella PC, Cholette JM, et al.; Pediatric Critical Care Blood Research Network (Blood Net): Transfusion-related immunomodulation: Review of the literature and implications for pediatric critical illness. Transfusion. 2017; 57:195–206
Cashen K, Dalton H, Reeder RW, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN): Platelet transfusion practice and related outcomes in pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2020; 21:178–185
Ozment CP, Scott BL, Bembea MM, et al.; Pediatric ECMO (PediECMO) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO): Anticoagulation and transfusion management during neonatal and pediatric extracorporeal membrane oxygenation: A survey of medical directors in the United States. Pediatr Crit Care Med. 2021; 22:530–541
Bateman ST, Lacroix J, Boven K, et al.; Pediatric Acute Lung Injury and Sepsis Investigators Network: Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med. 2008; 178:26–33
Karam O, Lacroix J, Robitaille N, et al.: Association between plasma transfusions and clinical outcome in critically ill children: A prospective observational study. Vox Sang. 2013; 104:342–349
Nellis ME, Karam O, Mauer E, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet), and the P3T Investigators: Platelet transfusion practices in critically ill children. Crit Care Med. 2018; 46:1309–1317
Alexander PMA, Bembea M, Cashen K, et al.; 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: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med. 2024; 25:643–675
Sterne JAC, Savovic J, Page MJ, et al.: RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898
Hayden JA, van der Windt DA, Cartwright JL, et al.: Assessing bias in studies of prognostic factors. Ann Intern Med. 2013; 158:280–286
Higgins JPT, Sterne JAC, Savovic J, et al.: A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. 2016; 10:29–31
Balshem H, Helfand M, Schunemann HJ, et al.: GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011; 64:401–406
Neumann I, Santesso N, Akl EA, et al.: A guide for health professionals to interpret and use recommendations in guidelines developed with the GRADE approach. J Clin Epidemiol. 2016; 72:45–55
Willems A, Anders MM, Garcia A, et al.; 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): Management of extracorporeal membrane oxygenation anticoagulation in the perioperative period: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med. 2024; 25 (Suppl 1):e53–65
Rintoul NE, McMichael ABV, Bembea MM, et al.; 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): Management of bleeding and thrombotic complications during pediatric extracorporeal membrane oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med. 2024; 25 (Suppl 1):e66–e77
Alonso-Coello P, Oxman AD, Moberg J, et al.; GRADE Working Group: GRADE Evidence to Decision (EtD) frameworks: A systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ. 2016; 353:i2089
Neumann I, Brignardello-Petersen R, Wiercioch W, et al.: The GRADE evidence-to-decision framework: A report of its testing and application in 15 international guideline panels. Implement Sci. 2016; 11:93
Diamond IR, Grant RC, Feldman BM, et al.: Defining consensus: A systematic review recommends methodologic criteria for reporting of Delphi studies. J Clin Epidemiol. 2014; 67:401–409
Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA Appropriateness Method User’s Manual. Santa Monica, CA, RAND, 2001
Friedman T, Javidroozi M, Lobel G, et al.: Complications of allogeneic blood product administration, with emphasis on transfusion-related acute lung injury and transfusion-associated circulatory overload. Adv Anesth. 2017; 35:159–173
Bembea MM, Cheifetz IM, Fortenberry JD, et al.; Pediatric Critical Care Transfusion and Anemia Expertise Initiative (TAXI): Recommendations on the indications for RBC transfusion for the critically ill child receiving support from extracorporeal membrane oxygenation, ventricular assist, and renal replacement therapy devices from the pediatric critical care transfusion and anemia expertise initiative. Pediatr Crit Care Med. 2018; 19(9S Suppl 1):S157–S162
Fiser RT, Irby K, Ward RM, et al.: RBC transfusion in pediatric patients supported with extracorporeal membrane oxygenation: Is there an impact on tissue oxygenation? Pediatr Crit Care Med. 2014; 15:806–813
Flores CJ, Lakkundi A, McIntosh J, et al.: Embedding best transfusion practice and blood management in neonatal intensive care. BMJ Open Qual. 2020; 9:e000694
Mueller MM, Van Remoortel H, Meybohm P, et al.; ICC PBM Frankfurt 2018 Group: Patient blood management: Recommendations from the 2018 Frankfurt Consensus Conference. BMJ Open Qual. 2020; 9:e000694
Faraoni D, Meier J, New HV, et al.: Patient blood management for neonates and children undergoing cardiac surgery: 2019 NATA guidelines. J Cardiothorac Vasc Anesth. 2019; 33:3249–3263
Nellis ME, Saini A, Spinella PC, et al.; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Pediatric Critical Care Blood Research Network (BloodNet), and the PlasmaTV Investigators and the P3T Investigators: Pediatric plasma and platelet transfusions on extracorporeal membrane oxygenation: A subgroup analysis of two large international point-prevalence studies and the role of local guidelines. Pediatr Crit Care Med. 2020; 21:267–275
Uhl L, Assmann SF, Hamza TH, et al.: Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial. Blood. 2017; 130:1247–1258
McMichael ABV, Hornik CP, Hupp SR, et al.: Correlation among antifactor Xa, activated partial thromboplastin time, and heparin dose and association with pediatric extracorporeal membrane oxygenation complications. ASAIO J. 2020; 66:307–313
Laine A, Niemi T, Suojaranta-Ylinen R, et al.: Decreased maximum clot firmness in rotational thromboelastometry (ROTEM®) is associated with bleeding during extracorporeal mechanical circulatory support. Perfusion. 2016; 31:625–633
Hellmann C, Schmutz A, Kalbhenn J: Bleeding during veno-venous ECMO cannot reliably be predicted by rotational thrombelastometry (ROTEM™). Perfusion. 2018; 33:289–296
Nellis ME, Dalton H, Karam O; PediECMO Investigators: Quantifiable bleeding in children supported by extracorporeal membrane oxygenation and outcome. Crit Care Med. 2019; 47:e886–e892
Keene SD, Patel RM, Stansfield BK, et al.: Blood product transfusion and mortality in neonatal extracorporeal membrane oxygenation. Transfusion. 2020; 60:262–268
Kumar TK, Zurakowski D, Dalton H, et al.: Extracorporeal membrane oxygenation in postcardiotomy patients: Factors influencing outcome. J Thorac Cardiovasc Surg. 2010; 140:330–336.e2
Smith A, Hardison D, Bridges B, et al.: Red blood cell transfusion volume and mortality among patients receiving extracorporeal membrane oxygenation. Perfusion. 2013; 28:54–60
Griffin MP, Minifee PK, Daeschner CW 3rd, et al.: Benefits of a lower hematocrit during extracorporeal membrane oxygenation? Am J Dis Child. 1992; 146:373–374
Hébert PC, Wells G, Blajchman MA, et al.: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999; 340:409–417
Lacroix J, Hébert PC, Hutchison JS, et al.; TRIPICU Investigators: Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007; 356:1609–1619
Holst LB, Haase N, Wetterslev J, et al.; TRISS Trial Group: Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014; 371:1381–1391
Lo Pinto H, Allyn J, Persichini R, et al.: Predictors of red blood cell transfusion and its association with prognosis in patients undergoing extracorporeal membrane oxygenation. Int J Artif Organs. 2018; 41:644–652
Abbasciano RG, Yusuff H, Vlaar APJ, et al.: Blood transfusion threshold in patients receiving extracorporeal membrane oxygenation support for cardiac and respiratory failure—a systematic review and meta-analysis. J Cardiothorac Vasc Anesth. 2021; 35:1192–1202
Spinella PC, Tucci M, Fergusson DA, et al.; ABC-PICU Investigators, the Canadian Critical Care Trials Group, the Pediatric Acute Lung Injury and Sepsis Investigators Network, the BloodNet Pediatric Critical Care Blood Research Network, and the Groupe Francophone de Réanimation et Urgences P: Effect of fresh vs standard-issue red blood cell transfusions on multiple organ dysfunction syndrome in critically ill pediatric patients: A randomized clinical trial. JAMA. 2019; 322:2179–2190
Datta S, Chang S, Jackson NJ, et al.: Impact of age of packed RBC transfusion on oxygenation in patients receiving extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2019; 20:841–846
Yoshida T, Prudent M, D’Alessandro A: Red blood cell storage lesion: Causes and potential clinical consequences. Blood Transfus. 2019; 17:27–52
Cooper DJ, McQuilten ZK, Nichol A, et al.; TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group: Age of red cells for transfusion and outcomes in critically ill adults. N Engl J Med. 2017; 377:1858–1867
Heddle NM, Cook RJ, Arnold DM, et al.: Effect of short-term vs. long-term blood storage on mortality after transfusion. N Engl J Med. 2016; 375:1937–1945
Lacroix J, Hebert PC, Fergusson DA, et al.; ABLE Investigators: Age of transfused blood in critically ill adults. N Engl J Med. 2015; 372:1410–1418
Steiner ME, Ness PM, Assmann SF, et al.: Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med. 2015; 372:1419–1429
Fergusson DA, Hebert P, Hogan DL, et al.: Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: The ARIPI randomized trial. JAMA. 2012; 308:1443–1451
Dela Cruz TV, Stewart DL, Winston SJ, et al.: Risk factors for intracranial hemorrhage in the extracorporeal membrane oxygenation patient. J Perinatol. 1997; 17:18–23
Doymaz S, Zinger M, Sweberg T: Risk factors associated with intracranial hemorrhage in neonates with persistent pulmonary hypertension on ECMO. J Intensive Care. 2015; 3:6
Nardell K, Annich GM, Hirsch JC, et al.: Risk factors for bleeding in pediatric post-cardiotomy patients requiring ECLS. Perfusion. 2009; 24:191–197
Saini A, Hartman ME, Gage BF, et al.: Incidence of platelet dysfunction by thromboelastography-platelet mapping in children supported with ECMO: A pilot retrospective study. Front Pediatr. 2015; 3:116
Stallion A, Cofer BR, Rafferty JA, et al.: The significant relationship between platelet count and haemorrhagic complications on ECMO. Perfusion. 1994; 9:265–269
Wild KT, Rintoul N, Kattan J, et al.: Extracorporeal Life Support Organization (ELSO): Guidelines for neonatal respiratory failure. ASAIO J. 2020; 66:463–470
Brown G, Moynihan KM, Deatrick KB, et al.: Extracorporeal Life Support Organization (ELSO): Guidelines for pediatric cardiac failure. ASAIO J. 2021; 67:463–475
Curley A, Stanworth SJ, Willoughby K, et al.; PlaNeT2 MATISSE Collaborators: Randomized trial of platelet-transfusion thresholds in neonates. N Engl J Med. 2019; 380:242–251
Robinson TM, Kickler TS, Walker LK, et al.: Effect of extracorporeal membrane oxygenation on platelets in newborns. Crit Care Med. 1993; 21:1029–1034
Karam O, Demaret P, Shefler A, et al.; Canadian Critical Care Trials Group (CCCTG): Indications and effects of plasma transfusions in critically ill children. Am J Respir Crit Care Med. 2015; 191:1395–1402
Church GD, Matthay MA, Liu K, et al.: Blood product transfusions and clinical outcomes in pediatric patients with acute lung injury. Pediatr Crit Care Med. 2009; 10:297–302
Nascimento B, Levy JH, Tien H, et al.: Cryoprecipitate transfusion in bleeding patients. Cjem. 2020; 22:S4–S11
Downey LA, Andrews J, Hedlin H, et al.: Fibrinogen concentrate as an alternative to cryoprecipitate in a postcardiopulmonary transfusion algorithm in infants undergoing cardiac surgery: A prospective randomized controlled trial. Anesth Analg. 2020; 130:740–751
Solomon C, Gröner A, Ye J, et al.: Safety of fibrinogen concentrate: Analysis of more than 27 years of pharmacovigilance data. Thromb Haemost. 2015; 113:759–771
Haas T, Spielmann N, Restin T, et al.: Higher fibrinogen concentrations for reduction of transfusion requirements during major paediatric surgery: A prospective randomised controlled trial. Br J Anaesth. 2015; 115:234–243
Faraoni D, Willems A, Savan V, et al.: Plasma fibrinogen concentration is correlated with postoperative blood loss in children undergoing cardiac surgery. A retrospective review. Eur J Anaesthesiol. 2014; 31:317–326
Fang ZA, Navaei AH, Hensch L, et al.: Hemostatic management of extracorporeal circuits including cardiopulmonary bypass and extracorporeal membrane oxygenation. Semin Thromb Hemost. 2020; 46:62–72
Galas FR, de Almeida JP, Fukushima JT, et al.: Hemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: A randomized pilot trial. J Thorac Cardiovasc Surg. 2014; 148:1647–1655
Callum J, Farkouh ME, Scales DC, et al.; FIBRES Research Group: Effect of fibrinogen concentrate vs cryoprecipitate on blood component transfusion after cardiac surgery: The FIBRES randomized clinical trial. JAMA. 2019; 322:1966–1976
Li JY, Gong J, Zhu F, et al.: Fibrinogen concentrate in cardiovascular surgery: A meta-analysis of randomized controlled trials. Anesth Analg. 2018; 127:612–621
Muszynski JA, Bembea MM, Gehred A, et al.; 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): Priorities for clinical research in pediatric extracorporeal membrane oxygenation anticoagulation from the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med. 2024; 25 (Suppl 1):e78–e89