PDF(Pubmed)
Abstract：
OBJECTIVE: To derive systematic review informed, modified Delphi consensus regarding monitoring and replacement of specific coagulation factors during pediatric extracorporeal membrane oxygenation (ECMO) support 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 2020, with an update in May 2021.
METHODS: Included studies assessed monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric ECMO support.
METHODS: Two authors reviewed all citations independently, with conflicts resolved by a third reviewer if required. Twenty-nine references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.
RESULTS: Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. A panel of 48 experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. We developed one weak recommendation and four expert consensus statements.
CONCLUSIONS: There is insufficient evidence to formulate recommendations on monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric patients on ECMO. Optimal monitoring and parameters for replacement of key hemostasis parameters is largely unknown.
METHODS: A structured literature search was performed using PubMed, Embase, and Cochrane Library (CENTRAL) databases from January 1988 to May 2020, with an update in May 2021.
METHODS: Included studies assessed monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric ECMO support.
METHODS: Two authors reviewed all citations independently, with conflicts resolved by a third reviewer if required. Twenty-nine references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.
RESULTS: Risk of bias was assessed using the Quality in Prognosis Studies tool. The evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation system. A panel of 48 experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was defined as greater than 80% agreement. We developed one weak recommendation and four expert consensus statements.
CONCLUSIONS: There is insufficient evidence to formulate recommendations on monitoring and replacement of antithrombin, fibrinogen, and von Willebrand factor in pediatric patients on ECMO. Optimal monitoring and parameters for replacement of key hemostasis parameters is largely unknown.
摘要：
目的：获得系统评价，关于儿科体外膜氧合（ECMO）期间特定凝血因子的监测和更换的改良Delphi共识支持儿科ECMO抗凝合作。
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2020年5月，在2021年5月更新。
方法：纳入的研究评估了抗凝血酶的监测和替代，纤维蛋白原，和vonWillebrand因子在儿科ECMO支持中的应用。
方法：两位作者独立回顾了所有引文，如果需要，由第三个审阅者解决冲突。29个参考文献用于数据提取和知情建议。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评估偏倚风险。使用建议分级评估来评估证据，发展,和评价体系。一个由48名专家组成的小组在两年内开会，制定基于证据的建议，当缺乏证据时，以专家为基础的共识声明。通过研究与开发/加利福尼亚大学适宜性方法，使用基于Web的修改的Delphi过程来建立共识。共识被定义为超过80％的协议。我们提出了一项薄弱的建议和四项专家共识声明。
结论：没有足够的证据来制定关于监测和替代抗凝血酶的建议，纤维蛋白原，和vonWillebrand因子在ECMO儿科患者中的应用。用于替换关键止血参数的最佳监测和参数在很大程度上是未知的。
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2020年5月，在2021年5月更新。
方法：纳入的研究评估了抗凝血酶的监测和替代，纤维蛋白原，和vonWillebrand因子在儿科ECMO支持中的应用。
方法：两位作者独立回顾了所有引文，如果需要，由第三个审阅者解决冲突。29个参考文献用于数据提取和知情建议。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评估偏倚风险。使用建议分级评估来评估证据，发展,和评价体系。一个由48名专家组成的小组在两年内开会，制定基于证据的建议，当缺乏证据时，以专家为基础的共识声明。通过研究与开发/加利福尼亚大学适宜性方法，使用基于Web的修改的Delphi过程来建立共识。共识被定义为超过80％的协议。我们提出了一项薄弱的建议和四项专家共识声明。
结论：没有足够的证据来制定关于监测和替代抗凝血酶的建议，纤维蛋白原，和vonWillebrand因子在ECMO儿科患者中的应用。用于替换关键止血参数的最佳监测和参数在很大程度上是未知的。
