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Bleeding Definitions in Pediatric Extracorporeal Membrane Oxygenation (ECMO) Studies: A Systematic Review and
Christie Atchison1, Madhuradhar Chegondi2, Nedaa Aldairi3
1From the Division of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 21, 2025
Summary
Bleeding definitions vary widely in pediatric extracorporeal membrane oxygenation (ECMO) studies. This heterogeneity in defining bleeding impacts reported prevalence rates in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Medical Informatics
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for severe cardiorespiratory failure in neonates and children.
- Patients on ECMO have a high risk of bleeding complications, necessitating standardized reporting.
- Existing research shows significant variability in how bleeding events are defined and reported in pediatric ECMO literature.
Purpose of the Study:
- To systematically review and report the diverse bleeding definitions used in studies involving pediatric ECMO.
- To assess the impact of heterogeneity in bleeding definitions on the reported prevalence of bleeding in this patient population.
- To analyze the commonality of specific definitions, such as intracranial hemorrhage and Extracorporeal Life Support Organization (ELSO) criteria.
Main Methods:
- A comprehensive meta-analysis was conducted, including studies from database inception to April 26, 2024.
- 169 studies, encompassing 154,046 subjects, were included after screening 6,482 records.
- Evaluation focused on the description of bleeding definitions and their reported prevalence, noting the inclusion of interventions like transfusions in 57% of definitions.
Main Results:
- A total of 69 distinct bleeding definitions were identified across the included studies.
- Intracranial hemorrhage (42 studies) and ELSO definitions (35 studies) were the most frequently employed.
- The overall pooled prevalence of bleeding was 33%. Excluding studies solely reporting intracranial bleeding, prevalence was 41% (ELSO definition) and 39% (other definitions), with substantial heterogeneity.
Conclusions:
- Significant variations in bleeding definitions contribute to the wide range of reported bleeding prevalence in pediatric ECMO.
- Inconsistent clinical practices regarding bleeding interventions may also influence prevalence estimates.
- Standardization of bleeding definitions is crucial for accurate comparison and interpretation of outcomes in pediatric ECMO research.
