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Executive Summary: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE) Consensus
Peta M A Alexander1, Melania M Bembea2, Katherine Cashen3
1Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA.
Summary
This study provides 91 consensus statements for managing anticoagulation in pediatric extracorporeal membrane oxygenation (ECMO) patients. These evidence-based guidelines aim to standardize care and inform future clinical trials for critically ill children on ECMO.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Hematology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for critically ill children with cardiorespiratory failure.
- Optimizing anticoagulation management is crucial for ECMO efficacy and patient safety, yet clinical practices vary.
- The Pediatric ECMO Anticoagulation CollaborativE (PEACE) initiative aimed to establish standardized guidelines.
Purpose of the Study:
- To develop evidence-based recommendations and consensus statements for the clinical management of anticoagulation in pediatric ECMO patients.
- To provide a comprehensive framework for anticoagulation care, addressing general management, perioperative considerations, and bleeding/thrombosis events.
- To identify knowledge gaps and research priorities in pediatric ECMO anticoagulation.
Main Methods:
- A systematic literature review was conducted across major databases (PubMed, Embase, Cochrane Library) from 1988 to 2021.
- International, interprofessional experts convened through serial meetings to develop statements.
- Consensus was achieved using the Research and Development/UCLA Appropriateness Method, with results graded by the GRADE system.
Main Results:
- A total of 91 statements were developed: 23 recommendations, 52 expert consensus statements, and 16 good practice statements.
- These statements cover general care, monitoring, perioperative management, and non-procedural bleeding or thrombosis.
- Three research-focused good practice statements were also identified, highlighting areas for future investigation.
Conclusions:
- The 91 consensus statements provide a foundation for standardizing anticoagulation management in pediatric ECMO.
- These guidelines are intended to improve clinical care and serve as a basis for future clinical trials.
- The PEACE initiative addresses critical aspects of anticoagulation, aiming to enhance outcomes for children on ECMO.
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