PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
METHODS: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.
METHODS: Anticoagulation monitoring of pediatric patients on ECMO.
METHODS: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form.
RESULTS: 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.
METHODS: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.
METHODS: Anticoagulation monitoring of pediatric patients on ECMO.
METHODS: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form.
RESULTS: 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.
摘要：
目的：获得系统评价，关于儿科ECMO抗凝合作的儿科体外膜氧合（ECMO）抗凝监测测定和目标水平的改良Delphi共识。
方法：使用PubMed进行了结构化文献检索，EMBASE,和Cochrane图书馆（CENTRAL）数据库，从1988年1月到2021年5月。
方法：儿科患者ECMO抗凝监测。
方法：两位作者独立回顾了所有引文，由第三位独立审阅者解决任何冲突。使用标准化的数据提取表格构建证据表。
结果：使用预后研究质量工具或修订的Cochrane随机试验的偏倚风险评估偏倚风险，酌情使用建议分级评估对证据进行评估，开发和评估系统。48名专家在两年内举行会议，制定基于证据的建议，当缺乏证据时，以专家为基础的临床建议共识声明侧重于抗凝监测和目标,使用基于网络的修改的Delphi流程建立共识(定义为>80%同意)。一个薄弱的建议，两个共识声明，并制定了三个良好做法声明，在所有,达成了超过80%的协议。我们还为ECMO临床医生在床边使用的抗凝监测提供了一些资源。
结论：在儿科ECMO期间制定最佳抗凝监测的证据不足，但是我们提出了一个建议，两个共识和三个良好做法声明。总的来说,现有的儿科证据不足,文献中存在显著空白.
方法：使用PubMed进行了结构化文献检索，EMBASE,和Cochrane图书馆（CENTRAL）数据库，从1988年1月到2021年5月。
方法：儿科患者ECMO抗凝监测。
方法：两位作者独立回顾了所有引文，由第三位独立审阅者解决任何冲突。使用标准化的数据提取表格构建证据表。
结果：使用预后研究质量工具或修订的Cochrane随机试验的偏倚风险评估偏倚风险，酌情使用建议分级评估对证据进行评估，开发和评估系统。48名专家在两年内举行会议，制定基于证据的建议，当缺乏证据时，以专家为基础的临床建议共识声明侧重于抗凝监测和目标,使用基于网络的修改的Delphi流程建立共识(定义为>80%同意)。一个薄弱的建议，两个共识声明，并制定了三个良好做法声明，在所有,达成了超过80%的协议。我们还为ECMO临床医生在床边使用的抗凝监测提供了一些资源。
结论：在儿科ECMO期间制定最佳抗凝监测的证据不足，但是我们提出了一个建议，两个共识和三个良好做法声明。总的来说,现有的儿科证据不足,文献中存在显著空白.
