. 2024 Jul 1;25(7 Suppl 1):e78-e89.

doi: 10.1097/PCC.0000000000003488. Epub 2024 Jul 3.

Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Jennifer A Muszynski¹, Melania M Bembea², Alison Gehred³, Elizabeth Lyman³, Katherine Cashen⁴, Ira M Cheifetz⁵, Heidi J Dalton⁶, Adam S Himebauch⁷, Oliver Karam^{8

9}, Katie M Moynihan^{10

11

12}, Marianne E Nellis¹³, Caroline Ozment¹⁴, Lakshmi Raman¹⁵, Natalie E Rintoul¹⁶, Ahmed Said¹⁷, Arun Saini¹⁸, Marie E Steiner¹⁹, Ravi R Thiagarajan^{10

11}, Kevin Watt²⁰, Ariane Willems²¹, Nicole D Zantek²², Ryan P Barbaro²³, Katherine Steffen²⁴, Adam M Vogel²⁵, Peta M A Alexander^{10

11}; Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)

Collaborators, Affiliations

Collaborators

Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO):
Peta M A Alexander, Melania M Bembea, Katherine Cashen, Ira M Cheifetz, Heidi J Dalton, Adam S Himebauch, Oliver Karam, Katie M Moynihan, Marianne E Nellis, Caroline Ozment, Lakshmi Raman, Natalie E Rintoul, Ahmed Said, Arun Saini, Marie E Steiner, Ravi R Thiagarajan, Kevin Watt, Ariane Willems, Nicole D Zantek, Ryan P Barbaro, Katherine Steffen, Adam M Vogel, Christopher Almond, Marc M Anders, Gail Annich, Leonardo R Brandão, Wayne Chandler, Megan Delaney, Robert DiGeronimo, Sitaram Emani, Samir Gadepalli, Alejandro V Garcia, Bereketeab Haileselassie, Adam S Himebauch, Robert Hyslop, Martin Kneyber, Lisa Baumann Kreuziger, Jennifer Le, Laura Loftis, Ali B V McMichael, D Michael McMullan, Paul Monagle, Kathleen Nicol, Matthew L Paden, Jason Patregnani, John Priest, Leslie Raffini, Lindsay M Ryerson, Steven Sloan, Jun Teruya, Andrew R Yates, Alison Gehred, Elizabeth Lyman, Jennifer A Muszynski

Affiliations

¹ Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, OH.
⁴ Department of Pediatrics, Duke Children's Hospital, Duke University, Durham, NC.
⁵ Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.
⁶ Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA.
⁷ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
⁸ Division of Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA.
⁹ Division of Critical Care Medicine, Yale School of Medicine, New Haven, CT.
¹⁰ Department of Cardiology, Boston Children's Hospital, Boston, MA.
¹¹ Department of Pediatrics, Harvard Medical School, Boston, MA.
¹² Faculty of Medicine and Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
¹³ Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell, New York, NY.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, Duke University and Duke University Health System, Durham, NC.
¹⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁶ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
¹⁷ Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
¹⁸ Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
¹⁹ Divisions of Hematology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
²⁰ Division of Clinical Pharmacology, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
²¹ Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
²² Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
²³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
²⁴ Department of Pediatrics (Pediatric Critical Care Medicine), Stanford University, Palo Alto, CA.
²⁵ Departments of Surgery and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.

PMID: 38959362
PMCID: PMC11216398
DOI: 10.1097/PCC.0000000000003488

Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Jennifer A Muszynski et al. Pediatr Crit Care Med. 2024.

. 2024 Jul 1;25(7 Suppl 1):e78-e89.

doi: 10.1097/PCC.0000000000003488. Epub 2024 Jul 3.

Authors

Collaborators

Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO):
Peta M A Alexander, Melania M Bembea, Katherine Cashen, Ira M Cheifetz, Heidi J Dalton, Adam S Himebauch, Oliver Karam, Katie M Moynihan, Marianne E Nellis, Caroline Ozment, Lakshmi Raman, Natalie E Rintoul, Ahmed Said, Arun Saini, Marie E Steiner, Ravi R Thiagarajan, Kevin Watt, Ariane Willems, Nicole D Zantek, Ryan P Barbaro, Katherine Steffen, Adam M Vogel, Christopher Almond, Marc M Anders, Gail Annich, Leonardo R Brandão, Wayne Chandler, Megan Delaney, Robert DiGeronimo, Sitaram Emani, Samir Gadepalli, Alejandro V Garcia, Bereketeab Haileselassie, Adam S Himebauch, Robert Hyslop, Martin Kneyber, Lisa Baumann Kreuziger, Jennifer Le, Laura Loftis, Ali B V McMichael, D Michael McMullan, Paul Monagle, Kathleen Nicol, Matthew L Paden, Jason Patregnani, John Priest, Leslie Raffini, Lindsay M Ryerson, Steven Sloan, Jun Teruya, Andrew R Yates, Alison Gehred, Elizabeth Lyman, Jennifer A Muszynski

Affiliations

¹ Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, OH.
² Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Grant Morrow III MD Medical Library, Nationwide Children's Hospital Columbus, OH.
⁴ Department of Pediatrics, Duke Children's Hospital, Duke University, Durham, NC.
⁵ Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.
⁶ Department of Pediatrics, INOVA Fairfax Medical Center, Falls Church, VA.
⁷ Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
⁸ Division of Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA.
⁹ Division of Critical Care Medicine, Yale School of Medicine, New Haven, CT.
¹⁰ Department of Cardiology, Boston Children's Hospital, Boston, MA.
¹¹ Department of Pediatrics, Harvard Medical School, Boston, MA.
¹² Faculty of Medicine and Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
¹³ Department of Pediatrics, Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital-Weill Cornell, New York, NY.
¹⁴ Division of Critical Care Medicine, Department of Pediatrics, Duke University and Duke University Health System, Durham, NC.
¹⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
¹⁶ Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.
¹⁷ Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO.
¹⁸ Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
¹⁹ Divisions of Hematology and Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN.
²⁰ Division of Clinical Pharmacology, Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
²¹ Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
²² Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN.
²³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
²⁴ Department of Pediatrics (Pediatric Critical Care Medicine), Stanford University, Palo Alto, CA.
²⁵ Departments of Surgery and Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.

PMID: 38959362
PMCID: PMC11216398
DOI: 10.1097/PCC.0000000000003488

Abstract

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.

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Conflict of interest statement

Drs. Muszynski and Alexander’s institutions received funding from the National Institutes of Health (NIH). Drs. Muszynski, Bembea, Himebauch, Barbaro, and Alexander received support for article research from the NIH. Dr. Bembea’s institution received funding from the National Institute of Neurologic Disorder and Stroke (R01NS106292) and a Grifols Investigator Sponsored Research Grant. Drs. Bembea, Steiner, and Thiagarajan’s institutions received funding from the Department of Defense. Dr. Cheifetz received funding from UptoDate. Dr. Dalton received funding from Innovative Extracorporeal Membrane Oxygenation (ECMO) Concepts, Entegrion, and Hemocue; she disclosed the off-label product use of ECMO equipment and drugs for anticoagulation. Dr. Himebauch receives support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K23HL153759. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr. Said acknowledges research support from the Children’s Discovery Institute Faculty Development Award at Washington University in St. Louis. Dr. Ozment received funding from Kaufman & Canoles Law Firm, Wiseman Ashworth Law Group, and Social Cascade; she disclosed the off-label product use of Heparin and bivalirudin use in neonatal and pediatric patients on ECMO. Dr. Steiner received funding from Octapharma, MedTronic, and PumpKIN DSMB; she disclosed the off-label product use of rFVIIA, TXA, Amicar, Kcentra. Dr. Thiagarajan received funding from the Society of Critical Care Medicine and the Extracorporeal Life Support Organization (ELSO). Dr. Zantek received funding from the North American Specialized Coagulation Laboratory Association (NASCOLA), the American Society for Apheresis (ASFA), and BloodNet; she disclosed that she is a Board Member of External Quality Assurance in Thrombosis and Hemostasis, a committee member of NASCOLA, ASFA, the Association for the Advancement of Blood and Biotherapies, the College of American Pathologists, and the International Society for Laboratory Hematology; she disclosed that her spouse is an employee of Boston Scientific and has a financial interest in Boston Scientific and Endo International. Dr. Barbaro’s institution received funding from the NIH (R01 HL153519 and K12 HL138039); he disclosed that he is a Board Member for ELSO and Co-Chair for Pedi-ECMO. Dr. Alexander’s institution received funding from ELSO and Novartis. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

1. Dalton HJ, Reeder R, Garcia-Filion P, et al. ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Factors associated with bleeding and thrombosis in children receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2017; 196:762–771 - PMC - PubMed
1. Organization ELS: International Summary—ECLS Registry Report July 30, 2023. 2023. Available at: https://www.elso.org/registry/internationalsummaryandreports/internation...
1. McMichael ABV, Ryerson LM, Ratano D, et al. : 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J. 2022; 68:303–310 - PubMed
1. Alexander PMA, Bembea M, Cashen K, et al. ; Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO): Executive summary: Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference. Pediatr Crit Care Med. 2024; 25:643–675
1. Alexander PMA, Muszynski JA: Ongoing variability in pediatric extracorporeal membrane oxygenation anticoagulation practices—could consensus change the next survey results? Pediatr Crit Care Med. 2021; 22:581–584 - PubMed

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Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Collaborators

Affiliations

Priorities for Clinical Research in Pediatric Extracorporeal Membrane Oxygenation Anticoagulation From the Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

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Medical