Plasma and Platelet Transfusions Strategies in Neonates and Children Undergoing Cardiac Surgery With Cardiopulmonary Bypass or Neonates and Children Supported by Extracorporeal Membrane Oxygenation: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

Jill M. Cholette, Jennifer A. Muszynski, Juan C. Ibla, Sitaram Emani, Marie E. Steiner, Adam M. Vogel, Robert I. Parker, Marianne E. Nellis, Melania M. Bembea

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Abstract

OBJECTIVES: To present the recommendations and consensus statements with supporting literature for plasma and platelet transfusions in critically ill neonates and children undergoing cardiac surgery with cardiopulmonary bypass or supported by extracorporeal membrane oxygenation from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. DESIGN: Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING: Not applicable. PATIENTS: Critically ill neonates and children following cardiopulmonary bypass or supported by extracorporeal membrane oxygenation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A panel of nine experts developed evidence-based and, when evidence was insufficient, expert-based statements for plasma and platelet transfusions in critically ill neonates and children following cardiopulmonary bypass or supported by extracorporeal membrane oxygenation. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed one good practice statement, two recommendations, and three expert consensus statements. CONCLUSIONS: Whereas viscoelastic testing and transfusion algorithms may be considered, in general, evidence informing indications for plasma and platelet transfusions in neonatal and pediatric patients undergoing cardiac surgery with cardiopulmonary bypass or those requiring extracorporeal membrane oxygenation support is lacking.

Original languageEnglish (US)
Pages (from-to)e25-e36
JournalPediatric Critical Care Medicine
Volume23
Issue numberSupplement 1 1S
DOIs
StatePublished - Jan 1 2022

Bibliographical note

Funding Information:
The Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding was supported, in part, by the National Institutes of Health National Heart, Lung and Blood Institute under award number R13 HL154544-01. Supported, in part, by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS106292 (to Dr. Bembea).

Funding Information:
Dr. Emani disclosed that he is a consultant for Chiesi Pharmaceuticals. Dr. Steiner received funding from Pumps for Kids, Infants, and Neonates (PumpKIN) Data Safety Monitoring Board and HealthCore. Drs. Nellis and Bembea received support for article research from the National Institutes of Health. Dr. Bembea’s institution received funding from the National Institute of Neurological Disorders and Stroke (R01NS106292), the National Institute of Child Health and Human Development, and Grifols Investigator Sponsored Research Grant. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Funding Information:
We would like to thank all members of the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding for their support and input, especially during the coronavirus disease 2019 pandemic. In addition, we thank the Chaire H?ma-Qu?bec-Bayer en m?decine transfusionnelle de l'Universit? de Montr?al, the Society for the Advancement of Blood Management, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis, the International Society of Blood Transfusion, the Society for Critical Care Medicine, and the AABB for their support.

Publisher Copyright:
© 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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