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Extracorporeal Membrane Oxygenation ComplicationPhase 4ECSTATICNCT05796557

ECMO Hemostatic Transfusions in Children

A Phase 4 study testing Platelet Transfusion in people with Extracorporeal Membrane Oxygenation Complication and Hemorrhage, run by Yale University at 10 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Critically ill children supported by extracorporeal membrane oxygenation (ECMO) receive large volumes of prophylactic platelet transfusions to prevent bleeding. However, mounting evidence has demonstrated significant morbidity and mortality associated with these transfusions. Read more about this study

Who is it for?
Ages Up to 18 years
What is being tested?
Platelet Transfusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
10 sitesin 2 countries
Study dates
12 Dec 2023to 25 Mar 2025
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Critically ill children (0 to <18 years of age)
  • Admitted to a participating pediatric, neonatal, or cardiac intensive care unite (PICU/NICU/CICU)
  • On extracorporeal Membrane Oxygenation (ECMO)
  • Who have either no bleeding or minimal bleeding, within 24 hours of cannulation. Minimal bleeding is defined as:
  • streaks of blood in endotracheal tube or during suctioning only
  • streaks of blood in nasogastric tube
Show all 10Show fewer
  • macroscopic hematuria
  • subcutaneous bleeding (including hematoma and petechiae) < 5 cm in diameter
  • quantifiable bleeding < 1mL/kg/hr (e.g., chest tube)
  • bloody dressings required to be changed no more often than each 6hr, or weighing no more than 1mL/kg/hr if weighed, due to slow saturation

Who cannot join

  • Post-conception age < 37 weeks at time of screening
  • Underlying oncologic diagnosis (defined as receipt of chemotherapy or radiation in the last six months) or recipient of bone marrow transplant in the last year
  • Congenital bleeding disorder
  • Pregnant or admitted post-partum
  • Decision to withdraw or withhold some critical care or interventions
  • Known objection to blood transfusions
  • On ECMO for > 24 hours at time of enrollment

Trial locations and contacts

10 sites in 2 countries.

10 sites in 2 countries

United States9 sites
  • Children's Healthcare of Atlanta - Emory

    Atlanta, Georgia, 30322

  • Duke University School of Medicine

    Durham, North Carolina, 27710

  • University of Iowa Health Care

    Iowa City, Iowa, 52242

  • Norton Children's Hospital

    Louisville, Kentucky, 40202

  • Children's Hospital of Wisconsin

    Milwaukee, Wisconsin, 53226

  • Morgan Stanley Children's Hospital of New York Presbyterian

    New York, New York, 10032

  • Komansky Children's Hospital of New York Presbyterian

    New York, New York, 10065

  • Children's Hospital of Richmond at VCU

    Richmond, Virginia, 23219

  • Golisano Children's Hospital

    Rochester, New York, 14642

Other trials in United States

Israel1 site
  • Schneider Children's Medical Center

    Petah Tikva, 49504

Other trials in Israel

About this study

Critically ill children supported by extracorporeal membrane oxygenation (ECMO) receive large volumes of prophylactic platelet transfusions to prevent bleeding. However, mounting evidence has demonstrated significant morbidity and mortality associated with these transfusions. The ECmo hemoSTAtic Transfusions In Children (ECSTATIC) pilot trial will test two different platelet transfusion strategies, based on two different platelet counts thresholds, one high (higher platelet transfusion strategy) and one low (lower platelet transfusion strategy). The pilot will gather the necessary information to perform a full trial which will provide a better understanding of how to transfuse platelets to children supported by ECMO and reduce the associated morbidity.

Read the detailed description

Due to coagulopathy and thrombocytopenia induced by hemodilution and the extracorporeal circuit itself, children supported by extracorporeal membrane oxygenation (ECMO) are at significant risk of bleeding. In order to prevent bleeding, pediatric intensivists often prescribe prophylactic platelet transfusions. However, in observational studies, prophylactic platelet transfusions to children on ECMO have been independently associated with increased thrombosis, mortality, and paradoxically, increased bleeding. Guidelines to direct platelet transfusions in this patient population are limited by the lack of evidence and therefore based on expert opinion alone. Given the significant associated risks, it is crucial to provide evidence to guide clinicians.

The ECSTATIC pilot, a randomized controlled trial endorsed by BloodNet, PediECMO, the Extracorporeal Life Support Organization (ELSO), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), will be conducted in ten sites (9 in the US and 1 in Israel). The investigators will enroll an anticipated 50 consecutive critically ill children (0 to <18 years of age), admitted to a participating pediatric, neonatal, or cardiac intensive care unit (PICU/NICU/CICU), on ECMO, and who have either no bleeding or minimal bleeding.

Non-bleeding children 0 to less than 18 years of age will be randomized 1:1 to either a platelet transfusion threshold of 90 x10e9/L (higher platelet transfusion strategy) or 50 x10e9/L (lower platelet transfusion strategy). Participants will be followed until progression to severe bleeding and/or severe thrombosis, decannulation from ECMO, or reach 21 days.

In this pilot, the investigators will test the separation between the lower and higher transfusion strategies. The primary outcomes will be the separation between pre-transfusion platelet counts, and the total platelet dose (in mL/kg/run). Secondary outcomes will be feasibility of patient enrollment and ability for an adjudication committee to determine the severity of bleeding and thrombotic outcomes.

The purpose of this pilot study is to determine the feasibility of the transfusion strategies, intervention parameters, subject availability, and other information regarding outcomes that are essential to complete the design of a large randomized controlled trial.

The large future trial will evaluate the efficacy of the two transfusion strategies, in terms of progression to severe bleeding and/or severe thrombosis. To adequately calculate the sample size, the investigators need to know the difference between the pre-transfusion platelet counts, the screening and inclusion rates, the proportion of patients who are consented within the first 24 hours after cannulation, the proportion of transfusions that are compliant with each arm's strategy, and the number of temporary suspensions.

The proposed pilot trial is innovative in that it is focused on children supported by ECMO, a population in whom transfusion strategies have never been tested previously; it involves the largest separation between the two arms of any platelet transfusion trial conducted in the past; and it involves two newly developed definitions of bleeding and thrombosis particularly applicable to children supported by ECMO.

The pilot trial will provide necessary and sufficient information to proceed with the definitive ECSTATIC Randomized Controlled Trial (RCT) to evaluate the impact of a lower prophylactic platelet transfusion threshold on the clinical outcomes in children on ECMO. ECSTATIC has the potential to optimize efficacy, to reduce platelet transfusion exposure and to decrease mortality and morbidity of these extremely ill infants and children.

Being tested
Platelet Transfusion
Keywords
Platelet transfusion, ECMO, Bleeding, Clotting, Mortality
Medical subject headings
Hemorrhage, Thromboembolism, Thrombosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Platelet TransfusionBiological

    Participants will be transfused according to the assigned threshold for each group, with a transfusion dose of 10 mL/kg, up to one adult unit.

Study groups in NCT05796557
Study groupRoleWhat they receive
Higher platelet transfusion strategyActive comparatorParticipants randomized to this arm will be transfused if the platelet count is < 90 x 10e9 cells/L.
Receives: Biological: Platelet Transfusion
Lower platelet transfusion strategyExperimentalParticipants randomized to this arm will be transfused if the platelet count is < 50 x 10e9 cells/L.
Receives: Biological: Platelet Transfusion

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total Platelet Transfusion Dose

    The total dose (in mL/kg/day) will be computed by the research team, by dividing the total platelet transfusion volume by the patient's weight at admission and the number of days of intervention.

    Measured: up to day 21

  2. Pre-transfusion Platelet Count

    Pre-transfusion platelet count, during intervention

    Measured: During intervention

Secondary outcomes (8)
  1. Feasibility Assessed by the Screening Rate

    Feasibility will be assessed by the number of eligible participants that were screened.

    Measured: At screening

  2. Feasibility Assessed by the Inclusion Rate

    Feasibility will be assessed by the number of eligible participants that were enrolled.

    Measured: At screening

  3. Feasibility Assessed by the Number of Informed Consents Signed in the First 24 Hours Post Cannulation.

    Feasibility will be assessed by the number of participants that sign consent within the first 24 hours after ECMO cannulation.

    Measured: At screening

  4. Compliance With Transfusion Thresholds

    The proportion of transfusions that were given for platelet counts below the arm threshold will be computed to assess compliance.

    Measured: up to Day 21

  5. Participants With at Least One Temporary Suspension

    The number of participants who required at least one temporary suspension during ECMO.

    Measured: up to Day 21

  6. Duration for Temporary Suspensions

    The investigators will collect information on the duration of each suspension.

    Measured: up to Day 21

  7. Progression to Composite Outcome of Severe Bleeding and/or Severe Thrombotic Event

    The investigators will collect the proportion of participants who progress to a composite outcome of severe bleeding and/or severe thrombosis. The outcome will be adjudicated by an external review committee, blinded to the allocation arm.

    Measured: up to Day 21

  8. Number of Participants Who Were Withdrawn and/or Lost to Follow-up

    Number of patients who withdraw from the study and/or are lost to follow-up (i.e., withdraw and/or are missing 90-day mortality assessment)

    Measured: Up to 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Apr 2023
  2. Study start12 Dec 2023
  3. Primary completion2 Jan 2025
  4. Study completion25 Mar 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Subjects will be randomized in a 1:1 ratio to either arm. Subjects will be stratified by type of extracorporeal membrane oxygenation (ECMO) support (Veno-Arterial vs Veno-Venous), by site, and by age (≤28 days vs \>28 days).
Masking
Double blind
Who is masked
Investigator, Outcomes assessor
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05796557
Sponsor's protocol ID
2000034604
Other IDs
1R34HL159119-01A1
Acronym
ECSTATIC
Status last verified
May 2025
First submitted
17 Mar 2023
Last updated
31 May 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The proposed research will include data from 50 critically ill subjects who are on extracorporeal life support (ECMO) enrolled at ten participating sites. The final dataset will include demographic and medical information, as well as laboratory data. After the investigators' proposed research is complete, each participating site will destroy the key linking this data to protected health information (PHI). Thus, the data will then be completely de-identified. However, the investigators believe that there remains the possibility of deductive disclosure of subjects with unusual characteristics, considering the variety of rare conditions leading to ECMO.

Publications

  • Nellis ME, Barney BJ, Coles G, Cholette JM, Choudhury TA, Furlong-Dillard J, Ozment C, Bain J, Niebler RA, Chegondi M, Badheka A, Schiller O, Shostak E, Joashi U, Paden M, Alvey JS, Muszynski JA, Spinella PC, Tucci M, Lacroix J, Stanworth S, O'Neil ER, Pollak U, Bahr T, Kumar SR, Karam O; BloodNet and PediECMO; subgroups of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). Platelet Transfusion Thresholds for Children Supported by Extracorporeal Membrane Oxygenation: The Extracorporeal Membrane Oxygenation Hemostatic Transfusions in Children (ECSTATIC) Feasibility Clinical Trial. Crit Care Med. 2026 Mar 1;54(3):410-421. doi: 10.1097/CCM.0000000000006995. Epub 2025 Dec 23.

    PubMed 41432485

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Platelet Transfusion in people with Extracorporeal Membrane Oxygenation Complication and Hemorrhage, run by Yale University at 10 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 31 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in United States, Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 31 May 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total Platelet Transfusion Dose (time frame: up to day 21). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05796557, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 May 2025.

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