Coagulation in pediatric extracorporeal membrane oxygenation: A systematic review of studies shows lack of standardized reporting

Abstract

Objectives Extracorporeal membrane oxygenation (ECMO) involves complex coagulation management and frequent hemostatic complications. ECMO practice between centers is variable. To compare results between coagulation studies, standardized definitions and clear documentation of ECMO practice is essential. We assessed how study population, outcome definitions, and ECMO‐, coagulation‐, and transfusion‐related parameters were described in pediatric ECMO studies. Data sources Embase, Medline, Web of Science, Cochrane Library and Google Scholar. Study selection English original studies of pediatric ECMO patients describing hemostatic tests or outcome. Data extraction Eligibility was assessed following PRISMA guidelines. Study population, outcome and ECMO‐, coagulation, and transfusion parameters were summarized. Data synthesis A total of 107 of 1312 records were included. Study population parameters most frequently included (gestational) age (79%), gender (60%), and (birth) weight (59%). Outcomes, including definitions of bleeding (29%), thrombosis (15%), and survival (43%), were described using various definitions. Description of pump type, oxygenator and cannulation mode occurred in 49%, 45%, and 36% of studies, respectively. The main coagulation test (53%), its reference ranges (49%), and frequency of testing (24%) were the most prevalent reported coagulation parameters. The transfusion thresholds for platelets, red blood cells, and fibrinogen were described in 27%, 18%, and 18% of studies, respectively. Conclusions This systematic review demonstrates a widespread lack of detail or standardization of several parameters in coagulation research of pediatric ECMO patients. We suggest several parameters that might be included in future coagulation studies. We encourage the ECMO community to adopt and refine this list of parameters and to use standardized definitions in future research.

Changes in von Willebrand Factor Multimers, Concentration, and Function During Pediatric Extracorporeal Membrane Oxygenation*

“…This could be due to a variety of differences between the two studies such as patient age, underlying pathophysiology, differences in ECMO circuitry, anticoagulation strategies, and VWF testing methods. Additionally, direct comparison of VWF in ECMO between studies can be challenging as often details regarding these variables, which may impact the results are lacking in the literature (17).…”

Balancing Pharmacologic Anticoagulation in Extracorporeal Membrane Oxygenation: Is It Now Time to Follow the Path Less Taken?*

“…Retrospective data collection, variable or imprecise outcome definitions, lack of consistent or comparable treatment regimens, and small sample size resulted in exclusion of many publications and impaired the ability to compare results across studies. While the need for standardization to facilitate ECMO-related research, particularly in areas addressing anticoagulation practices, has long been recognized, standardized anticoagulation regimens have not been adopted (6, 7, 21–25). However, a reduction in bleeding and thrombotic complications in ECMO following the application of standardized decision-making processes has been demonstrated in a few studies (26, 27), suggesting that broader standardization may result in meaningful improvement in how we manage anticoagulation in pediatric ECMO.…”