ECMO-/ECLS

Cardiology, and Infectious Disease Society of America. A consensus guideline is
typically developed by a group of national and international experts who review and
grade the available literature on a specific disease or therapy, and then make varying
levels of treatment recommendations based on the strength of evidence to support the
recommendation. An important example of consensus guidelines in critical care is the
“Surviving Sepsis Campaign: International Guidelines for the Management of Severe
Sepsis and Septic Shock”; these guidelines are sponsored by several medical societies
and are periodically revised to incorporate the latest available research [ 29 - 32 ]. The
2012 revision of these guidelines will be published in early 2013.
An additional issue for pediatric critical care physicians is the availability of a
large number of studies in adult patients with limited or no data available in children.
Specific issues to consider prior to translating these studies to pediatric surgery are the
specific endpoints measured and the length follow-up. Much adult critical care research
will report in-hospital or 30 day primary outcomes such as death, pulmonary embolism,
stroke, deep venous thrombosis, or myocardial infarction. Although these outcomes are
important, they occur much less frequently in children and may not be the best primary
outcome measures to determine the effectiveness of therapy in our patient population.
In addition, our patient population is unique in that they are growing and developing,
therefore measuring longer term outcomes, including assessments of the
developmental and social impacts of our therapies, should be considered in pediatric
critical care trials.