Abstract
Objectives: To make practical and evidence-based recommendations on improving understanding of bleeding and thrombosis with pediatric extracorporeal life support and to make recommendations for research directions. Data Sources: Evaluation of literature and consensus conferences of pediatric critical care and extracorporeal life support experts. Study Selection: A team of 10 experts with pediatric cardiac and extracorporeal membrane oxygenation experience and expertise met through the Pediatric Cardiac Intensive Care Society to review current knowledge and make recommendations for future research to establish "best practice" for anticoagulation management related to extracorporeal life support. Data Extraction/Synthesis: The first of a two-part white article focuses on clinical understanding and limitations of medications in use for anticoagulation, including novel medications. For each medication, limitations of current knowledge are addressed and research recommendations are suggested to allow for more definitive clinical guidelines in the future. Conclusions: No consensus on best practice for anticoagulation exists. Structured scientific evaluation to answer questions regarding anticoagulant medication and bleeding and thrombotic events should occur in multicenter studies using standardized approaches and well-defined endpoints. Outcomes related to need for component change, blood product administration, healthcare outcome, and economic assessment should be incorporated into studies. All centers should report data on patients receiving extracorporeal life support to a registry. The Extracorporeal Life Support Organization registry, designed primarily for quality improvement purposes, remains the primary and most successful data repository to date.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1027-1033 |
| Number of pages | 7 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 20 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2019 |
Funding
each of the institutions listed above for the authors. se of extracorporeal membrane oxygenation (ECMO) and the American Heart Association. Dr. Thiagarajan’s institution receivedDr. Reddy’s institution received funding from the National Institutes of Health for pediatric patients continues to expand (1). Critical funding from Bristol Myers Squibb and Pfizer. Dr. Dalton received funding Uillness and exposure of blood to the ECMO circuit cre-from Innovative ECMO Concepts (consultant), and she disclosed off-label ate a prothrombotic state and a risk of bleeding. The primary have disclosed that they do not have any potential conflicts of interest.product use of extracorporeal membrane oxygenation. The remaining authors mediator of clot formation when the blood contacts nonbiologic For information regarding this article, E-mail: [email protected] ECMO surface is thrombin. Activation of thrombin is associated Copyright © 2019 by the Society of Critical Care Medicine and the World with two common complications during ECMO: bleeding and Federation of Pediatric Intensive and Critical Care Societies thrombosis. Generation of thrombin leads to consumption of DOI: 10.1097/PCC.0000000000002054 platelets and coagulation factors. In areas of native tissue injury,
Keywords
- anticoagulation
- extracorporeal membrane oxygenation
- hemorrhage
- heparin
- pediatrics
- thrombosis
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Critical Care and Intensive Care Medicine