目的:获得系统评价,关于新生儿和儿童抗纤维蛋白溶解和辅助止血药的改良的Delphi共识,在儿科ECMO抗凝合作共识会议上获得体外膜氧合(ECMO)支持.
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:使用抗纤维蛋白溶解药(ε-氨基己酸[EACA]或氨甲环酸),重组因子VII活化(rFVIIa),或局部止血剂(THA)。
方法:两位作者独立回顾了所有引文,与第三位独立审阅者解决冲突。11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。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,以专家为基础的儿科ECMO患者出血和血栓性并发症管理共识声明.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。提出了一项薄弱的建议和三项共识声明。
结论:支持抗纤溶药物(EACA或氨甲环酸)给药建议的证据,rFVIIa,和THA是稀疏和不确定的。仍有许多工作要确定有效和安全的使用策略。
OBJECTIVE: To derive systematic-review informed, modified Delphi
consensus regarding antifibrinolytic and adjunct hemostatic agents in neonates and children supported with extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE
consensus conference.
METHODS: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.
METHODS: Use of antifibrinolytics (epsilon-aminocaproic acid [EACA] or tranexamic acid), recombinant factor VII activated (rFVIIa), or topical hemostatic agents (THAs).
METHODS: Two authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Eleven 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. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for the management of bleeding and thrombotic complications in pediatric ECMO patients. 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. One weak recommendation and three
consensus statements are presented.
CONCLUSIONS: Evidence supporting recommendations for administration of antifibrinolytics (EACA or tranexamic acid), rFVIIa, and THAs were sparse and inconclusive. Much work remains to determine effective and safe usage strategies.