@article{3fd50f4fb9464ac0a55c2156d763360c,
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 2∗",
abstract = "Objectives: To make recommendations on improving understanding of bleeding and thrombosis with pediatric extracorporeal life support including future 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/Data Synthesis: This white paper focuses on clinical understanding and limitations of current strategies to monitor anticoagulation. For each test of anticoagulation, limitations of current knowledge are addressed and future research directions suggested. Conclusions: No consensus on best practice for anticoagulation monitoring exists. Structured scientific evaluation to answer questions regarding anticoagulation monitoring 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 patient receiving extracorporeal life support to a registry.",
keywords = "anticoagulation, extracorporeal membrane oxygenation, hemorrhage, monitoring, pediatrics, thrombosis",
author = "Penk, {Jamie S.} and Sushma Reddy and Angelo Polito and Cisco, {Michael J.} and Allan, {Catherine K.} and Melania Bembea and Giglia, {Therese M.} and Cheng, {Henry H.} and Thiagarajan, {Ravi R.} and Dalton, {Heidi J.}",
note = "Funding Information: *See also p. 1089. 1Division of Pediatric Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children{\textquoteright}s Hospital of Chicago, Chicago, IL. 2Division of Pediatric Cardiology, Department of Pediatrics, Stanford Uni- versity, Stanford, CA. 3Division of Neonatalogy and Pediatric Intensive Care, Department of Pe- diatrics, University Hospital of Geneva, Geneva, Switzerland. 4Division of Critical Care Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA. 5Division of Cardiac Critical Care, Department of Cardiology, Boston Chil- dren{\textquoteright}s Hospital, Harvard Medical School, Boston, MA. 6Department of Anesthesiology and Critical Care Medicine, Johns Hop- kins University School of Medicine, Baltimore, MD. 7Division of Cardiology, Department of Pediatrics, The Children{\textquoteright}s Hospital of Philadelphia, Perelman School of Medicine at the University of Penn- sylvania, Philadelphia, PA. 8Department of Cardiology, Boston Children{\textquoteright}s Hospital, Harvard Medical School, Boston, MA. 9Department of Pediatrics, INOVA Fairfax Hospital, Falls Church, VA. The work for this project occurred during monthly phone meetings and at each of the institutions listed above for the authors. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s website (http://journals.lww.com/pccmjournal). Despite decades of clinical experience using extracor-Health and the American Heart Association. Dr. Thiagarajan{\textquoteright}s institution Dr. Reddy{\textquoteright}s institution received funding from the National Institutes of poreal membrane oxygenation (ECMO), advances in received funding from Bristol Myers Squibb and Pfizer. Dr. Dalton received understanding of pediatric hemostasis, and advances funding from Innovative Extracorporeal Membrane Oxygenation (ECMO) in circuit design, rates of bleeding and thrombosis in pedi-The remaining authors have disclosed that they do not have any potential Concepts (consultant), and she disclosed off-label product use of ECMO. atric ECMO remain unacceptably high (1). Part 1 of this series conflicts of interest. reviewed anticoagulation strategies, with proposals for future For information regarding this article, E-mail: jamiepenk@gmail.com research. In part 2, we focus on monitoring of anticoagulation. Publisher Copyright: {\textcopyright} 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",
year = "2019",
month = nov,
day = "1",
doi = "10.1097/PCC.0000000000002104",
language = "English (US)",
volume = "20",
pages = "1034--1039",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
publisher = "Lippincott Williams and Wilkins",
number = "11",
}