Recommendations on Monitoring and Replacement of Antithrombin, Fibrinogen, and Von Willebrand Factor in Pediatric Patients on Extracorporeal Membrane Oxygenation: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.

IF 4 2区医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-03 DOI:10.1097/PCC.0000000000003492

Nicole D Zantek, Marie E Steiner, Jun Teruya, Lisa Baumann Kreuziger, Leslie Raffini, Jennifer A Muszynski, Peta M A Alexander, Alison Gehred, Elizabeth Lyman, Kevin Watt

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Abstract

Objectives: To derive systematic review informed, modified Delphi consensus regarding monitoring and replacement of specific coagulation factors during pediatric extracorporeal membrane oxygenation (ECMO) support for the Pediatric ECMO Anticoagulation CollaborativE.

Data sources: A structured literature search was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2020, with an update in May 2021.

Study selection: Included studies assessed monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric ECMO support.

Data extraction: Two authors reviewed all citations independently, with conflicts resolved by a third reviewer if required. Twenty-nine references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.

Data synthesis: Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. A panel of 48 experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. We developed one weak recommendation and four expert consensus statements.

Conclusions: There is insufficient evidence to formulate recommendations on monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric patients on ECMO. Optimal monitoring and parameters for replacement of key hemostasis parameters is largely unknown.

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关于体外膜氧合治疗儿科患者抗凝血酶、纤维蛋白原和冯-威廉因子监测和补充的建议》：儿科体外膜氧合抗凝协作共识会议。

目标：就儿科体外膜肺氧合（ECMO）支持过程中特定凝血因子的监测和置换问题，为儿科 ECMO 抗凝协作项目（Pediatric ECMO Anticoagulation CollaborativE）达成有系统综述依据的改良德尔菲共识：数据来源：使用 PubMed、Embase 和 Cochrane Library (CENTRAL) 数据库对 1988 年 1 月至 2020 年 5 月期间的文献进行了结构化检索，并于 2021 年 5 月进行了更新：纳入的研究评估了儿科 ECMO 支持中抗凝血酶、纤维蛋白原和冯-威廉因子的监测和替代情况：两位作者独立审阅了所有引用文献，如有冲突，由第三位审阅者解决。29 篇参考文献用于数据提取和知情建议。使用标准化数据提取表构建了证据表：使用预后研究质量工具评估偏倚风险。采用建议分级评估、制定和评价系统对证据进行评估。一个由 48 位专家组成的小组历时 2 年召开会议，制定了基于证据的建议，并在缺乏证据的情况下制定了基于专家共识的声明。通过 "研究与发展"/加利福尼亚大学的 "适当性方法"，采用基于网络的改良德尔菲流程来达成共识。共识的定义是大于 80% 的一致意见。我们提出了一项弱建议和四项专家共识声明：结论：目前尚无充分证据可用于制定有关 ECMO 儿科患者抗凝血酶、纤维蛋白原和冯-威廉因子的监测和替代建议。关键止血参数的最佳监测和替代参数在很大程度上尚属未知。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.