Related Experiment Video
Updated: Sep 28, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Coagulation in pediatric extracorporeal membrane oxygenation: A systematic review of studies shows lack of
Joppe Drop1,2, Suelyn Van Den Helm3, Paul Monagle3,4,5,6
1Pediatric Hematology Erasmus University Medical Center - Sophia Children's Hospital Rotterdam The Netherlands.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) studies lack standardized coagulation reporting. This review highlights inconsistencies in reporting parameters, crucial for improving patient outcomes and research comparability.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Cardiopulmonary bypass
Background:
- Extracorporeal membrane oxygenation (ECMO) management is complex, particularly coagulation.
- Significant variability exists in ECMO practices across centers.
- Frequent hemostatic complications necessitate clear documentation and standardized definitions for research.
Purpose of the Study:
- To assess the reporting of study population, outcome definitions, and ECMO-, coagulation-, and transfusion-related parameters in pediatric ECMO studies.
- To identify inconsistencies in data reporting within the field.
- To provide recommendations for standardized reporting in future research.
Main Methods:
- Systematic review of English original studies on pediatric ECMO patients.
- Searched Embase, Medline, Web of Science, Cochrane Library, and Google Scholar.
- Data extraction and summarization followed PRISMA guidelines, focusing on specific parameters.
Main Results:
- 107 studies were included, revealing significant heterogeneity in reporting.
- Outcome definitions for bleeding (29%), thrombosis (15%), and survival (43%) varied widely.
- Coagulation testing frequency (24%) and transfusion thresholds (platelets 27%, fibrinogen 18%) were inconsistently reported.
Conclusions:
- Pediatric ECMO coagulation research suffers from a lack of detailed and standardized parameter reporting.
- Standardized definitions and documentation of key parameters are essential for future research.
- Adoption of a refined list of parameters by the ECMO community is encouraged.
Objectives:
Extracorporeal membrane oxygenation (ECMO) involves complex coagulation management and frequent hemostatic complications. ECMO practice between centers is variable. To compare results between coagulation studies, standardized definitions and clear documentation of ECMO practice is essential. We assessed how study population, outcome definitions, and ECMO-, coagulation-, and transfusion-related parameters were described in pediatric ECMO studies.
Data Sources:
Embase, Medline, Web of Science, Cochrane Library and Google Scholar.
Study Selection:
English original studies of pediatric ECMO patients describing hemostatic tests or outcome.
Data Extraction:
Eligibility was assessed following PRISMA guidelines. Study population, outcome and ECMO-, coagulation, and transfusion parameters were summarized.
Data Synthesis:
A total of 107 of 1312 records were included. Study population parameters most frequently included (gestational) age (79%), gender (60%), and (birth) weight (59%). Outcomes, including definitions of bleeding (29%), thrombosis (15%), and survival (43%), were described using various definitions. Description of pump type, oxygenator and cannulation mode occurred in 49%, 45%, and 36% of studies, respectively. The main coagulation test (53%), its reference ranges (49%), and frequency of testing (24%) were the most prevalent reported coagulation parameters. The transfusion thresholds for platelets, red blood cells, and fibrinogen were described in 27%, 18%, and 18% of studies, respectively.
Conclusions:
This systematic review demonstrates a widespread lack of detail or standardization of several parameters in coagulation research of pediatric ECMO patients. We suggest several parameters that might be included in future coagulation studies. We encourage the ECMO community to adopt and refine this list of parameters and to use standardized definitions in future research.
