Bleeding and Thrombosis With Pediatric Extracorporeal Life Support: A Roadmap for Management, Research, and the Future From the Pediatric Cardiac Intensive Care Society: Part 1

Jamie S. Penk, Sushma Reddy, Angelo Polito, Michael J. Cisco, Catherine K. Allan, Melania M. Bembea, Therese M. Giglia, Henry H. Cheng, Ravi R. Thiagarajan, Heidi J. Dalton

Research output: Contribution to journalArticle

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.

Fingerprint

Extracorporeal Membrane Oxygenation
Thrombosis
Pediatrics
Hemorrhage
Research
Practice Guidelines
Registries
Practice Management
Critical Care
Quality Improvement
Anticoagulants
Multicenter Studies
Economics
Outcome Assessment (Health Care)
Organizations
Guidelines
Delivery of Health Care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Bleeding and Thrombosis With Pediatric Extracorporeal Life Support : A Roadmap for Management, Research, and the Future From the Pediatric Cardiac Intensive Care Society: Part 1. / Penk, Jamie S.; Reddy, Sushma; Polito, Angelo; Cisco, Michael J.; Allan, Catherine K.; Bembea, Melania M.; Giglia, Therese M.; Cheng, Henry H.; Thiagarajan, Ravi R.; Dalton, Heidi J.

In: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, Vol. 20, No. 11, 01.11.2019, p. 1027-1033.

Research output: Contribution to journalArticle

@article{ab394b57925c452f9daa44e04ff63f7f,
title = "Bleeding and Thrombosis With Pediatric Extracorporeal Life Support: A Roadmap for Management, Research, and the Future From the Pediatric Cardiac Intensive Care Society: Part 1",
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.",
author = "Penk, {Jamie S.} and Sushma Reddy and Angelo Polito and Cisco, {Michael J.} and Allan, {Catherine K.} and Bembea, {Melania M.} and Giglia, {Therese M.} and Cheng, {Henry H.} and Thiagarajan, {Ravi R.} and Dalton, {Heidi J.}",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/PCC.0000000000002054",
language = "English (US)",
volume = "20",
pages = "1027--1033",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Bleeding and Thrombosis With Pediatric Extracorporeal Life Support

T2 - A Roadmap for Management, Research, and the Future From the Pediatric Cardiac Intensive Care Society: Part 1

AU - Penk, Jamie S.

AU - Reddy, Sushma

AU - Polito, Angelo

AU - Cisco, Michael J.

AU - Allan, Catherine K.

AU - Bembea, Melania M.

AU - Giglia, Therese M.

AU - Cheng, Henry H.

AU - Thiagarajan, Ravi R.

AU - Dalton, Heidi J.

PY - 2019/11/1

Y1 - 2019/11/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85074553199&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074553199&partnerID=8YFLogxK

U2 - 10.1097/PCC.0000000000002054

DO - 10.1097/PCC.0000000000002054

M3 - Article

C2 - 31274779

AN - SCOPUS:85074553199

VL - 20

SP - 1027

EP - 1033

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

SN - 1529-7535

IS - 11

ER -