• Natalie E Rintoul, Ali B V McMichael, Melania M Bembea, Robert DiGeronimo, Jason Patregnani, AlexanderPeta M APMADepartment of Cardiology, Boston Children's Hospital, Boston, MA.Department of Pediatrics, Harvard Medical School, Boston, MA., Jennifer A Muszynski, Katherine Steffen, Alison Gehred, Elizabeth Lyman, Ira M Cheifetz, and Pediatric Extracorporeal Membrane Oxygenation (ECMO) Anticoagulation Collaborative (PEACE), in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric ECMO subgroup of PALISI and the Extracorporeal Life Support .
• Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
• Pediatr Crit Care Me. 2024 Jul 1; 25 (7 Suppl 1): e66e77e66-e77.

ObjectivesTo derive systematic-review informed, modified Delphi consensus regarding the management of bleeding and thrombotic complications during pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE Consensus Conference.Data SourcesA structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.Study SelectionThe management of bleeding and thrombotic complications of ECMO.Data ExtractionTwo authors reviewed all citations independently, with a third independent reviewer resolving conflicts. Twelve references were used for data extraction and informed recommendations. Evidence tables were constructed using a standardized data extraction form.Data SynthesisRisk 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. Two good practice statements, 5 weak recommendations, and 18 consensus statements are presented.ConclusionsAlthough bleeding and thrombotic complications during pediatric ECMO remain common, limited definitive data exist to support an evidence-based approach to treating these complications. Research is needed to improve hemostatic management of children supported with ECMO.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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