Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference
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Jennifer A Muszynski1, Melania M Bembea2, Alison Gehred3
1Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
Insights
Pediatric experts identified research priorities for anticoagulation and hemostasis in neonates and children on extracorporeal membrane oxygenation (ECMO). Further research is needed in five key domains to improve care for these critically ill patients.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Cardiopulmonary support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill neonates and children.
- Anticoagulation and hemostasis management during ECMO is complex and requires careful consideration.
Purpose of the Study:
- To identify and prioritize critical research questions for anticoagulation and hemostasis in pediatric ECMO.
- To inform future research and improve clinical management strategies.
Main Methods:
- Systematic literature review of PubMed, EMBASE, and Cochrane Library (CENTRAL) from 1988 to 2021.
- Consensus conferences involving international, interprofessional experts in pediatric ECMO.
- Application of the Child Health and Nutrition Research Initiative methodology for research prioritization.
Main Results:
- Twenty research topics were prioritized by the Pediatric ECMO Anticoagulation CollaborativE (PEACE) panel.
- Prioritized topics fall into five domains: definitions and outcomes, therapeutics, anticoagulant monitoring, protocolized management, and ECMO circuit impact on hemostasis.
- Established a framework for future research in pediatric ECMO anticoagulation and hemostasis.
Conclusions:
- The PEACE panel has outlined crucial research priorities for pediatric ECMO.
- Addressing these research gaps is essential for advancing the care and improving outcomes for neonates and children on ECMO.
- Further investigation is needed to optimize anticoagulation and hemostasis management in this vulnerable population.
Objectives:
To identify and prioritize research questions for anticoagulation and hemostasis management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus.
Data Sources:
Systematic review was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial consensus conferences of international, interprofessional experts in the management of ECMO for critically ill neonates and children.
Study Selection:
The management of ECMO anticoagulation for critically ill neonates and children.
Data Extraction:
Within each of the eight subgroups, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts.
Data Synthesis:
Following the systematic review of MEDLINE, EMBASE, and Cochrane Library databases from January 1988 to May 2021, and the consensus process for clinical recommendations and consensus statements, PEACE panel experts constructed research priorities using the Child Health and Nutrition Research Initiative methodology. Twenty research topics were prioritized, falling within five domains (definitions and outcomes, therapeutics, anticoagulant monitoring, protocolized management, and impact of the ECMO circuit and its components on hemostasis).
Conclusions:
We present the research priorities identified by the PEACE expert panel after a systematic review of existing evidence informing clinical care of neonates and children managed with ECMO. More research is required within the five identified domains to ultimately inform and improve the care of this vulnerable population.
