Abstract
Objectives
Despite advances in Extracorporeal Membranous Oxygenation (ECMO) equipment, hematologic
complications remain significant in critically ill children. The aim of this study
is to summarize prevalence of hematologic complications for children and neonates.
Methods
MEDLINE, PubMed and Scopus databases were searched focusing on the period from January
01, 2017 to October 01, 2022. The population included critically ill children and
neonates with hematologic complications. The review included all aspects of related
complications including hemorrhage, thrombosis, and hemolysis. We performed random
effects meta-analyses. The primary outcome measure was overall hematologic complications.
Secondary outcomes are changes in the prevalence of hemorrhagic complications. Risk
of bias of included studies was assessed using the Joanna Briggs Institute checklist.
Results
The systematic search identified 37 studies totaling 10,659 critically ill pediatric
patients receiving ECMO. The pooled prevalence of hemorrhagic complications, thrombotic
complications and hemolysis among pediatric patients requiring ECMO was 43.7 % (95 %
CI: 28.6 % to 58.9 %, P < 0.001), 27.6 % (95 % CI: 20.4 % to 34.8 %, P < 0.001), 34.3 % (95 % CI: 22.9 % to 45.7 %, P < 0.001). The prevalence of hemorrhagic complications was represented in descending
order: surgical site (21.6 %, 95 % CI: 10.3 % to 32.9 %); cannulation site (20.6 %,
95 % CI: 11.8 % to 29.3 %); intracranial (12.2 %, 95 % CI: 9.5 % to 15.0 %); pulmonary
(7.7 %, 95 % CI: 5.9 % to 9.6 %); gastrointestinal (6.0 %, 3.7 % to 8.4 %). For the
assessment of thrombotic complications, thrombosis in cannulation site had a higher
prevalence (28.5 %, 95 % CI: 22.1 % to 34.9 %), followed by DIC (13.5 %, 95 % CI:
8.7 % to 18.3 %) and intracranial thrombosis (4.5 %, 95 % CI: 1.4 % to 7.6 %). Predictors
of increased prevalence of hemorrhagic complications included age (P = 0.017) and VV-ECMO support mode (P = 0.029).
Conclusions
Among critically ill pediatric patients, there was a series of hematologic complications
can occur during ECMO support. Physicians should pay special attention to the management
and establish appropriate treatment programs to reduce the occurrence of hematologic
complications.
Keywords
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Article info
Publication history
Published online: December 28, 2022
Accepted:
December 20,
2022
Received in revised form:
December 13,
2022
Received:
October 18,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
