Evidence map›Paper›PMID 41432485›Full record

Trial reportCritical care medicine2026

Platelet Transfusion Thresholds for Children Supported by Extracorporeal Membrane Oxygenation: The Extracorporeal Membrane Oxygenation Hemostatic Transfusions in Children (ECSTATIC) Feasibility Clinical Trial.

Marianne E Nellis, Bradley J Barney, Garrett Coles, Jill M Cholette, Tarif A Choudhury, Jamie Furlong-Dillard, Caroline Ozment, Jesse Bain, Robert A Niebler, Madhuradhar Chegondi and 18 more

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in Critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Marianne E NellisDepartment of Pediatrics, Weill Cornell Medicine, New York, NY.
Bradley J BarneyDepartment of Pediatrics, University of Utah, Salt Lake City, UT.
Garrett ColesDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY.
Jill M CholetteDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY.
Tarif A ChoudhuryDivisions of Pediatric Critical Care Medicine and Pediatric Cardiology, Morgan Stanley Children's Hospital, Columbia University School of School of Medicine, New York, NY.
Jamie Furlong-DillardDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville Norton Children's Hospital, Louisville, KY.
Caroline OzmentPediatric Critical Care Medicine, Duke University, Durham, NC.
Jesse BainDivision of Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, VA.
Robert A NieblerDivision of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Madhuradhar ChegondiPediatric Critical Care Medicine, University of Illinois College of Medicine and Children's Hospital of Illinois at OSF HealthCare, Peoria, IL.
Aditya BadhekaDivision of Critical Care, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA.
Ofer SchillerPediatric Cardiac ICU, Schneider Children's Medical Center, Petach-Tikva and Tel-Aviv University Faculty of Medicine and Health Sciences, Tel-Aviv, Israel.
Eran ShostakPediatric Cardiac ICU, Schneider Children's Medical Center, Petach-Tikva and Tel-Aviv University Faculty of Medicine and Health Sciences, Tel-Aviv, Israel.
Umesh JoashiDepartment of Pediatrics, Weill Cornell Medicine, New York, NY.
Matthew PadenDepartment of Pediatrics, Children's Healthcare of Atlanta-Emory, Atlanta, GA.
Jessica S AlveyData Coordinating Center, Utah Data Coordinating Center, University of Utah, Salt Lake City, UT.
Jennifer A MuszynskiDivision of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Philip C SpinellaDepartment of Surgery, Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, PA.
Marisa TucciDepartment of Pediatrics, Pediatric Critical Care Medicine Service, Sainte-Justine Hospital, Université de Montreal, Montreal, QC, Canada.
Jacques LacroixDepartment of Pediatrics, Pediatric Critical Care Medicine Service, Sainte-Justine Hospital, Université de Montreal, Montreal, QC, Canada.
Simon StanworthDepartment of Medicine, John Radcliffe Hospital, Oxford, United Kingdom.
Erika R O'NeilUnited States Air Force, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX.
Uri PollakDepartment of Pediatrics, Section of Pediatric Critical Care, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
Timothy BahrDivision of Neonatalogy, Department of Pediatrics, University of Utah, Salt Lake City, UT.
S Ram KumarDivision of Pediatric Cardiothoracic Surgery, Children's Nebraska and University of Nebraska Medical Center, Omaha, NE.
Oliver KaramDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Yale, CT.
BloodNet and PediECMO
subgroups of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Funding

Utah Trial Innovation CenterU24TR001597 · NCATS · UNIVERSITY OF UTAH · PI DEAN, JONATHAN MICHAEL · 2016 to 2022
$39.6M
ECmo hemoSTAtic Transfusions In Children (ECSTATIC)R34HL159119 · NHLBI · YALE UNIVERSITY · PI KARAM, OLIVER L, NELLIS, MARIANNE · 2022 to 2024
$830k
NCATS NIH HHS U24 TR001597NHLBI NIH HHS R34 HL159119
6 · The paper itself

Abstract

objectivesTo evaluate the feasibility of randomizing children on extracorporeal membrane oxygenation (ECMO) to one of two prophylactic platelet transfusion thresholds.

designRandomized controlled trial.

settingTen ECMO centers (nine in United States, one in Israel). PATIENTS: Critically ill children (0 to younger than 18 yr), supported on ECMO, with no or minimal bleeding within 24 hours of cannulation.

interventionsChildren were randomized to a higher platelet threshold (transfused when platelet count < 90 × 10 9 /L) or a lower platelet threshold (transfused when platelet count < 50 × 10 9 /L). Primary feasibility outcome was pre-transfusion platelet count to test for a difference between strategies. Primary safety outcome was progression to severe bleeding, severe clotting, and/or all-cause mortality. MEASUREMENTS AND MAIN

resultsOf 159 patients screened for eligibility, 77% (123/159) met eligibility criteria. Sixty-five percent (80/123) of caregivers were approached for consent. Consent was obtained in 63% (50/80). Enrolled children had a median age of 0.2 years (interquartile range 0.0; 1.7) and 88% (44/50) were supported by veno-arterial (V-A) ECMO. The model-adjusted mean difference in pre-transfusion platelet count between the groups was 32 × 10 9 /L ( p < 0.001). Compliance with assigned transfusion threshold was 99.2%. Eleven (22%) children experienced the primary safety outcome. Progression to severe bleeding occurred in 14% (7/50) of patients, whereas progression to severe clotting was observed in 4% (2/50).

conclusionsNon-bleeding children on ECMO can be screened, enrolled and randomized to different platelet transfusion strategies within 24 hours of cannulation. Compliance with the protocol was excellent with significant separation in pre-transfusion platelet counts between the arms. Severe bleeding and severe clotting occurred at similar rates in both thresholds. A larger, definitive trial is feasible and needed.

Indexed as

Extracorporeal Membrane OxygenationHemorrhagePlatelet TransfusionAdolescentChildChild, PreschoolCritical IllnessFeasibility StudiesFemaleHumansInfantInfant, NewbornMalePlatelet Countchildrencritical illnessextracorporeal membrane oxygenationhemorrhageplatelet transfusionthrombosis

Identifiers

PMID41432485
PMCPMC13036739

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.