• Marianne E Nellis, Katie M Moynihan, Steven R Sloan, Meghan Delaney, KneyberMartin C JMCJPediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands., Robert DiGeronimo, AlexanderPeta M APMADepartment of Cardiology, Boston Children's Hospital, Boston, MA.Department of Pediatrics, Harvard Medical School, Boston, MA., Jennifer A Muszynski, Alison Gehred, Elizabeth Lyman, Oliver Karam, and Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE (PEACE), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, and the Pe.
• Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital-Weill Cornell Medicine, New York, NY.
• Pediatr Crit Care Me. 2024 Jul 1; 25 (7 Suppl 1): e25e34e25-e34.

ObjectivesTo derive systematic-review informed, modified Delphi consensus regarding prophylactic transfusions in neonates and children supported with extracorporeal membrane oxygenation (ECMO) from the Pediatric ECMO Anticoagulation CollaborativE.Data SourcesA 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.Study SelectionIncluded studies assessed use of prophylactic blood product transfusion in pediatric ECMO.Data ExtractionTwo authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Thirty-three references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.Measurements And Main ResultsThe evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-informed recommendations and, when evidence was lacking, expert-based consensus statements or good practice statements for prophylactic transfusion strategies for children supported with ECMO. A web-based modified Delphi process was used to build consensus via the Research And Development/University of California Appropriateness Method. Consensus was based on a modified Delphi process with agreement defined as greater than 80%. We developed two good practice statements, 4 weak recommendations, and three expert consensus statements.ConclusionsDespite the frequency with which pediatric ECMO patients are transfused, there is insufficient evidence to formulate evidence-based prophylactic transfusion strategies.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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