Research & Projects

Bleeding is one of the most serious complications in critically ill children on ECMO, yet there is no consensus on how to optimize platelet transfusions to balance bleeding and clotting risks. Our lab has led groundbreaking studies evaluating the impact of different platelet transfusion thresholds on patient outcomes. We conducted the first randomized controlled trial comparing two platelet transfusion strategies on ECMO, providing crucial data to guide clinical practice. Building on this work, we are now leading ECSTATIC, the largest international randomized trial on platelet transfusions in ECMO patients, spanning 90 sites in 15 countries. Our goal is to develop evidence-based transfusion guidelines that improve survival and reduce complications in this vulnerable population.

Bleeding is one of the most serious complications in critically ill children on ECMO, significantly contributing to morbidity and mortality. However, there is no universally accepted definition for bleeding severity, making it difficult to compare studies and establish standardized treatment protocols. Our lab conducted a systematic review, revealing that the literature includes more than 50 different bleeding definitions, many of which are imprecise and inconsistent. This lack of standardization has hindered the ability to accurately assess bleeding severity and its impact on patient outcomes.

Through large-scale ECMO dataset analyses, we have demonstrated a dose-response relationship between chest tube bleeding and mortality, underscoring the need for standardized bleeding definitions to guide transfusion strategies and anticoagulation management.

To address this critical gap, we actively participated in an international effort to develop a novel, standardized definition of bleeding severity on ECMO. As part of the Academic Research Consortium ECMO Core Elements Needed for Trials, Regulation, and Quality of Life (ECMO-CENTRAL ARC), we contributed to a consensus framework that provides clear, evidence-based criteria for defining bleeding events in ECMO patients. This initiative is a critical step toward improving research consistency, clinical decision-making, and patient outcomes in ECMO care.

Managing anticoagulation on ECMO is a delicate balance—too much increases bleeding risk, too little leads to clotting complications. While most current anticoagulation strategies focus on coagulation factors, they often neglect platelet function, a key component of hemostasis. Our lab is working to bridge this gap by evaluating both established and novel anticoagulation approaches to improve patient safety and outcomes.

We have systematically assessed commonly used anticoagulants, such as heparin and bivalirudin, comparing their efficacy and safety profiles in ECMO patients. In addition, we are pioneering research into novel therapies that better address platelet function. We are currently evaluating the potential of prostaglandin E1 and I2, which could offer a more comprehensive anticoagulation approach by modulating platelet activity alongside traditional coagulation factor management.

Furthermore, we are investigating the benefits of antithrombin administration, aiming to refine anticoagulation strategies to reduce both bleeding and thrombotic risks. By expanding the scope of anticoagulation beyond traditional approaches, our research seeks to optimize ECMO management, minimize complications, and improve patient outcomes.

Managing anticoagulation on ECMO is a complex challenge—too much increases bleeding risk, too little leads to clotting complications. Despite its critical importance, there is no consensus on the optimal anticoagulation monitoring strategy. Our lab is leading efforts to refine monitoring approaches to improve patient safety and outcomes.

Our research has demonstrated that Anti-Xa monitoring reduces bleeding risk compared to traditional aPTT-based strategies. In a meta-analysis, we showed that patients monitored with Anti-Xa had a 50% lower bleeding rate, emphasizing the need for updated clinical guidelines. Additionally, we identified that commonly used anticoagulation tests are discordant more than 50% of the time, often leading to unnecessary dose adjustments and increased risk of complications.

By systematically evaluating novel anticoagulation monitoring techniques, our goal is to provide clinicians with real-time, precise tools to prevent both hemorrhage and clotting in ECMO patients. Our work is paving the way for evidence-based anticoagulation protocols, ensuring safer ECMO management for critically ill children.

For parents, ECMO is more than a medical procedure—it is a life-altering experience, often accompanied by significant psychological distress. Many parents develop post-traumatic stress disorder (PTSD), anxiety, and depression following their child's ECMO course.

Our lab is dedicated to identifying modifiable risk factors that contribute to parental trauma and designing interventions to improve family outcomes. We have completed a systematic review on parental PTSD after ECMO and are conducting qualitative interviews with ECMO parents to better understand their experiences. Additionally, we are leading a large international point-prevalence study to determine the true impact of ECMO on families and lay the foundation for targeted support interventions that promote resilience and mental well-being.