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

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.
Competing Interests: 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.
(Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)