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Antifibrinolytic and Adjunct Hemostatic Agents: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation

Katie M Moynihan1,2,3,4,5,6,7,8,9,10,11,12,13,14, Lindsay M Ryerson4,5, Jennifer Le6

  • 1Department of Cardiology, Boston Children's Hospital, Boston, MA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|July 3, 2024
PubMed

Insights

Evidence for antifibrinolytics and hemostatic agents in pediatric extracorporeal membrane oxygenation (ECMO) is limited. Further research is needed to establish safe and effective usage strategies for these critical treatments.

Area of Science:

  • Pediatric critical care medicine
  • Hematology
  • Extracorporeal life support

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates and children with severe cardiorespiratory failure.
  • Bleeding and thrombotic complications are significant challenges during pediatric ECMO.
  • Antifibrinolytic and hemostatic agents are often considered to manage these complications, but evidence is scarce.

Purpose of the Study:

  • To establish consensus on the use of antifibrinolytics and adjunct hemostatic agents in pediatric ECMO patients.
  • To provide evidence-based recommendations and expert consensus statements for managing bleeding and thrombotic issues.
  • To inform the Pediatric ECMO Anticoagulation CollaborativE consensus conference.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, EMBASE, Cochrane Library) from 1988 to 2021.
  • A modified Delphi process involving 48 experts was used to develop recommendations and consensus statements.
  • Evidence quality was assessed using GRADE, and risk of bias was evaluated using the Quality in Prognosis Studies tool.

Main Results:

  • The study identified sparse and inconclusive evidence for antifibrinolytics (epsilon-aminocaproic acid, tranexamic acid), recombinant factor VII activated (rFVIIa), and topical hemostatic agents (THAs).
  • One weak recommendation and three consensus statements were generated.
  • Consensus was defined as greater than 80% agreement among experts.

Conclusions:

  • Current evidence supporting the use of antifibrinolytics, rFVIIa, and THAs in pediatric ECMO is limited and inconclusive.
  • Significant research is required to determine optimal and safe strategies for employing these agents.
  • Further studies are essential to guide clinical practice in managing hemostatic complications during pediatric ECMO.
Abstract

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