Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation.
OBJECTIVE
In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO.


METHODS
Prospective observational study in 20 neonates (0.17-5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms.


RESULTS
Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0-24.1 h). Median interruption duration for midazolam was 16.5 h (6.6-29.6 h), and for morphine was 11.2 h (6.7-39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred.


CONCLUSIONS
This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2-3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes.
Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Dr Molewaterplein 60, 3000 CB, Rotterdam, The Netherlands.
E D
ED
Wildschut
M N
MN
Hanekamp
N J
NJ
Vet
R J
RJ
Houmes
M J
MJ
Ahsman
R A A
RA
Mathot
S N
SN
de Wildt
D
D
Tibboel
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000379:methods*; D056805:Consciousness Monitors; D003422:Critical Care / Q000379:methods; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008874:Midazolam / Q000008:administration & dosage*; D009020:Morphine / Q000008:administration & dosage*; D009460:Neurologic Examination; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam