Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference
Research article published in Pediatric critical care medicine (2024)
Abstract
OBJECTIVES: To derive systematic-review informed, modified Delphi consensus regarding anticoagulation monitoring assays and target levels in pediatric extracorporeal membrane oxygenation (ECMO) 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 2021. STUDY SELECTION: Anticoagulation monitoring of pediatric patients on ECMO. DATA EXTRACTION: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS: Risk of bias was assessed using the Quality in Prognosis Studies tool or the revised Cochrane risk of bias for randomized trials, as appropriate and 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 clinical recommendations focused on anticoagulation monitoring and targets, using a web-based modified Delphi process to build consensus (defined as > 80% agreement). One weak recommendation, two consensus statements, and three good practice statements were developed and, in all, agreement greater than 80% was reached. We also derived some resources for anticoagulation monitoring for ECMO clinician use at the bedside. CONCLUSIONS: There is insufficient evidence to formulate optimal anticoagulation monitoring during pediatric ECMO, but we propose one recommendation, two consensus and three good practice statements. Overall, the available pediatric evidence is poor and significant gaps exist in the literature.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Zusammenfassung
Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference.
Warum dies für die Hirudotherapie relevant ist
Diese durch ein systematisches Review informierte Konsensuserklärung des Pediatric ECMO Anticoagulation Collaborative befasst sich mit Antikoagulationsmonitoring-Assays und Zielwerten in der pädiatrischen extrakorporalen Membranoxygenierung (ECMO). Über einen Zeitraum von zwei Jahren entwickelten 48 Experten mittels modifiziertem Delphi-Prozess (>80 % Übereinstimmung) eine schwache Empfehlung, zwei Konsensusaussagen und drei Good-Practice-Statements. Die Autoren schlussfolgerten, dass die Evidenz unzureichend ist, um ein optimales Antikoagulationsmonitoring während der pädiatrischen ECMO zu definieren, mit signifikanten Lücken in der Literatur. Die Relevanz für die ASH und die Hirudotherapie ist lediglich indirekt: Das Abstract erwähnt weder Blutegel, Hirudin noch Bivalirudin spezifisch, sondern fokussiert stattdessen auf das allgemeine Antikoagulationsmanagement. Obwohl Antikoagulation konzeptuell benachbart zu aus Blutegeln gewonnenen Therapeutika ist, liefert dieses Dokument keine direkten Daten zu blutegelstämmigen Agenzien und sollte eher als Hintergrundkontext denn als primäre Hirudotherapie-Literatur betrachtet werden.
Zitation
Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference
Ozment CP et al. · Pediatric critical care medicine, 2024
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