Recommendations on the indications for RBC transfusion for the critically ill child receiving support from extracorporeal membrane oxygenation, ventricular assist, and renal replacement therapy devices from the pediatric critical care transfusion and Anemia expertise initiative

Melania M. Bembea, Ira M. Cheifetz, James D. Fortenberry, Timothy E. Bunchman, Stacey L. Valentine, Scot T. Bateman, Marie E. Steiner

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objectives: To present recommendations and supporting literature for RBC transfusions in critically ill children supported with extracorporeal membrane oxygenation, ventricular assist devices, or renal replacement therapy. Design: Consensus conference series of international, multidis-ciplinary experts in RBC transfusion management of critically ill children. Methods: The panel of 38 experts developed evidence-based, and when evidence was lacking, expert-based clinical recommendations as well as research priorities for RBC transfusions in critically ill children. The extracorporeal membrane oxygenation/ventricular assist device/renal replacement therapy subgroup included six experts. We conducted electronic searches of the PubMed, EMBASE, and Cochrane Library databases jrom 1980 to May 2017, using medical subject heading terms and text words to define concepts of RBC transfusion, extracorporeal membrane oxygenation, ventricular assist device, and renal replacement therapy. We used a standardized data extraction form to construct evidence tables and graded the evidence using the Grading of Recommendations Assessment, Development, and Evaluation system. Recommendations developed and supporting literature were reviewed and scored by all panel members. Agreement was obtained using the Research and Development/UCLA Appropriateness Method. Results: For inpatients requiring extracorporeal membrane oxygenation, ventricular assist device, or renal replacement therapy support, there was expert agreement (> 80%) on five good practice statements aimed to improve accuracy and uniform reporting of RBC transfusion data in pediatric extracorporeal membrane oxygenation, ventricular assist device, and renal replacement therapy studies and quality improvement projects; four clinical recommendations of physiologic metrics and biomarkers of oxygen delivery, in addition to hemoglobin concentration, to guide RBC transfusion, acknowledging insufficient evidence to recommend specific RBC transfusion strategies; and eight research recommendations. Conclusions: Further research surrounding indications, risks, benefits, and alternatives to RBC transfusion in children on extra-corporeal devices is clearly needed. Using a structured literature review and grading process, the Transfusion and Anemia Expertise Initiative panel concluded that there is currently insufficient evidence to recommend specific RBC transfusion variables in children requiring extracorporeal membrane oxygenation, ventricular assist device, or renal replacement therapy support.

Original languageEnglish (US)
Pages (from-to)S157-S162
JournalPediatric Critical Care Medicine
Volume19
Issue number9
DOIs
StatePublished - 2018

Bibliographical note

Funding Information:
The Transfusion and Anemia Expertise Initiative was supported, in part, by the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management (SABM)-Haemonetics Research Starter Grant, the CHU-Sainte-Justine Foundation, the Washington University Children's Discovery Institute (CDI-E1-2015-499), and the University of Massachusetts Medical School. Dr. Bembea received support from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) under award number K23NS076674. Dr. Bembea's institution also received funding from NIH/NINDS K23NS076674, and she disclosed off-label product use of ECMO. Drs. Bembea's and Valentine's institutions received funding from Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI) under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management (SABM) SABM-Haemonetics Research Starter Grant, and Washington University Children's Discovery Institute (CDI-E1-2015-499). Dr. Valentine received support for article research from the NIH, SABM SABM-Haemonetics Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University Children's Discovery Institute, and the University of Massachusetts Medical School. Dr. Bembea, Bateman, and Steiner received support for article research from the NIH. Dr. Cheifetz received funding from Philips (medical advisor) and UptoDate (contributor). Dr. Fortenberry received funding from Davis and Snyder LLC and disclosed that he provided expert testimony for a law firm defending physicians. Dr. Bateman's institution received funding from SABM. Dr. Bateman's and Steiner's institutions received funding from R13 conference grant from the NICHD and NHLBI. Dr. Bunchman has disclosed that he does not have any potential conflicts of interest.

Funding Information:
Institute of Child Health and Human Development (NICHD) and National Heart, Lung, and Blood Institute (NHLBI) under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management (SABM) SABM-Haemonetics Research Starter Grant, and Washington University Children’s Discovery Institute (CDI-E1-2015–499). Dr. Valentine received support for article research from the NIH, SABM SABM-Haemonetics Research Starter Grant, CHU-Sainte-Justine Foundation, Washington University Children’s Discovery Institute, and the University of Massachusetts Medical School. Dr. Bembea, Bateman, and Steiner received support for article research from the NIH. Dr. Cheifetz received funding from Philips (medical advisor) and UptoDate (contributor). Dr. Fortenberry received funding from Davis and Snyder LLC and disclosed that he provided expert testimony for a law firm defending physicians. Dr. Bateman’s institution received funding from SABM. Dr. Bateman’s and Steiner’s institutions received funding from R13 conference grant from the NICHD and NHLBI. Dr. Bunchman has disclosed that he does not have any potential conflicts of interest. For information regarding this article, E-mail: mbembea1@jhmi.edu

Funding Information:
Dr. Bembea received support from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH) under award number K23NS076674. Dr. Bembea’s institution also received funding from NIH/NINDS K23NS076674, and she disclosed off-label product use of ECMO. Drs. Bembea’s and Valentine’s institutions received funding from Eunice Kennedy Shriver National

Funding Information:
The Transfusion and Anemia Expertise Initiative was supported, in part, by the National Institutes of Health Eunice Kennedy Shriver National Institute of Child Health and Human Development and National Heart, Lung, and Blood Institute under award number 1 R13 HD088086-01, the Society for the Advancement of Blood Management (SABM)-Haemonetics Research Starter Grant, the CHU-Sainte-Justine Foundation, the Washington University Children’s Discovery Institute (CDI-E1-2015–499), and the University of Massachusetts Medical School.

Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

Keywords

  • Blood
  • Extracorporeal life support
  • Pediatric critical care
  • Renal replacement therapy
  • Transfusion
  • Ventricular assist device

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