Pediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Pediatrics, Section of Pediatric Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Pediatr Crit Care Med. 2024 Jul 1;25(7 Suppl 1):e53-e65. doi: 10.1097/PCC.0000000000003490. Epub 2024 Jul 3.
To derive systematic review-informed, modified Delphi consensus regarding the management of children on extracorporeal membrane oxygenation (ECMO) undergoing invasive procedures or interventions developed by the Pediatric Anticoagulation on ECMO CollaborativE (PEACE) Consensus Conference.
A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.
ECMO anticoagulation and hemostasis management in the perioperative period and during procedures.
Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Seventeen references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.
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. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. 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. Four good practice statements, 7 recommendations, and 18 consensus statements are presented.
Although agreement among experts was strong, important future research is required in this population for evidence-informed recommendations.
根据儿科体外膜肺氧合（ECMO）抗凝协作组（PEACE）共识会议制定的系统评价，为正在接受侵入性操作或干预的 ECMO 患儿的管理提供循证修改后的德尔菲共识。
使用 PubMed、EMBASE 和 Cochrane Library（CENTRAL）数据库，从 1988 年 1 月至 2021 年 5 月进行了结构化文献检索。
ECMO 抗凝和围手术期及操作期间止血管理。
两名作者独立审查所有引用，第三名独立评审员解决任何冲突。使用了 17 篇参考文献进行数据提取和知情推荐。使用标准化数据提取表构建证据表。
使用预后研究质量工具评估偏倚风险。使用推荐评估、制定和评估系统评估证据。48 名专家在 2 年内会面，制定了循证推荐，以及在缺乏证据的情况下，制定了针对儿科 ECMO 患者出血和血栓并发症管理的专家共识声明。使用基于网络的修改后的 Delphi 流程，通过研究与开发/加利福尼亚大学适宜性方法来建立共识。共识定义为超过 80%的同意。提出了 4 项良好实践声明、7 项建议和 18 项共识声明。
尽管专家之间的意见一致，但该人群仍需要进行重要的未来研究，以提供基于证据的建议。
