Executive Summary: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE) Consensus Conference*
Authors: Alexander Peta M. A. , Bembea Melania M. , Cashen Katherine , Cheifetz Ira M. , Dalton Heidi J. , Himebauch Adam S. , Karam Oliver , Moynihan Katie M. , Nellis Marianne E. , Ozment Caroline , Raman Lakshmi , Rintoul Natalie E. , Said Ahmed S. , Saini Arun , Steiner Marie E. , Thiagarajan Ravi R. , Watt Kevin , Willems Ariane , Zantek Nicole D. , Barbaro Ryan P. , Steffen Katherine , Vogel Adam M. , Almond Christopher , Anders Marc M. , Annich Gail M. , Brandão Leonardo R. , Chandler Wayne , Delaney Megan , DiGeronimo Robert , Emani Sitaram , Gadepalli Samir K. , Garcia Alejandro V. , Haileselassie Bereketeab , Hyslop Robert , Kneyber Martin C. J. , Baumann Kreuziger Lisa , Le Jennifer , Loftis Laura , McMichael Ali B. V. , McMullan D. Michael , Monagle Paul , Nicol Kathleen , Paden Matthew L. , Patregnani Jason , Priest John , Raffini Leslie , Ryerson Lindsay M. , Sloan Steven R. , Teruya Jun , Yates Andrew R. , Gehred Alison , Lyman Elizabeth , Muszynski Jennifer A. ,   for the Pediatric ECMO Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support Organization (PediECMO)
Published: July 2024

OBJECTIVES:

To present recommendations and consensus statements with supporting literature for the clinical management of neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE (PEACE) consensus conference.

DATA SOURCES:

Systematic review was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021, followed by serial meetings of international, interprofessional experts in the management ECMO for critically ill children.

STUDY SELECTION:

The management of ECMO anticoagulation for critically ill children.

DATA EXTRACTION:

Within each of eight subgroup, two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts.

DATA SYNTHESIS:

A systematic review was conducted using MEDLINE, Embase, and Cochrane Library databases, from January 1988 to May 2021. Each panel developed evidence-based and, when evidence was insufficient, expert-based statements for the clinical management of anticoagulation for children supported with ECMO. These statements were reviewed and ratified by 48 PEACE experts. Consensus was obtained using the Research and Development/UCLA Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed 23 recommendations, 52 expert consensus statements, and 16 good practice statements covering the management of ECMO anticoagulation in three broad categories: general care and monitoring; perioperative care; and nonprocedural bleeding or thrombosis. Gaps in knowledge and research priorities were identified, along with three research focused good practice statements.

CONCLUSIONS:

The 91 statements focused on clinical care will form the basis for standardization and future clinical trials.