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抗纤维解质和辅助静血剂:儿科外体膜氧化抗凝协作共识会议共识会议

Katie M Moynihan^{1,2,3,4,5,6,7,8,9,10,11,12,13,14}, Lindsay M Ryerson^4,5, 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

概括

在儿科外体膜氧化 (ECMO) 中抗纤维解药和静血剂的证据有限. 需要进一步的研究,以建立安全和有效的使用策略,为这些关键的治疗.

科学领域:

儿科重症监护医药儿科重症监护医药
血液学血液学血液学
身体之外的生命支持.

背景情况:

身体外膜氧化 (ECMO) 是对新生儿和患有严重心肺衰竭的儿童的生命支持措施.
流血和血栓并发症是儿科ECMO期间的重大挑战.
抗纤维解质和静血剂通常被认为可以治疗这些并发症,但证据很少.

研究的目的:

建立关于在儿科ECMO患者中使用抗纤维解压剂和辅助血静剂的共识.
为管理出血和血栓问题提供基于证据的建议和专家共识陈述.
为儿童ECMO抗凝血合作共识会议提供信息.

主要方法:

从1988年到2021年,主要数据库 (PubMed,EMBASE,Cochrane图书馆) 进行了系统的文献搜索.
一个经过修改的Delphi流程,涉及48名专家,用于制定建议和共识声明.
使用GRADE评估证据质量,使用预后研究中的质量工具评估偏差风险.

主要成果:

该研究发现了抗纤维解药 (epsilon-aminocaproic acid,tranexamic acid),活性复合因子VII (rFVIIa) 和局部血液静止剂 (THAs) 的稀疏且不确的证据.
产生了一个弱点建议和三个共识声明.
共识被定义为专家之间超过80%的共识.

结论:

目前支持使用抗纤维解药,rFVIIa和THAs在儿科ECMO的证据有限且不确.
需要大量的研究来确定使用这些药物的最佳和安全策略.
进一步的研究对于指导临床实践在儿科ECMO期间管理静血并发症至关重要.

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