Evaluation of sedatives, analgesics, and neuromuscular blocking agents in adults receiving extracorporeal membrane oxygenation.
The objective of this study was to evaluate the use of sedative, analgesic, and neuromuscular blocking agents (NMBAs) in patients undergoing extracorporeal membrane oxygenation (ECMO) support.



This was a 2-year, prospective, observational study of adult intensive care unit patients on ECMO support for more than 48hours.



We analyzed 32 patients, including 15 receiving VA (venoarterial) ECMO and 17 VV (venovenous) ECMO. The median daily dose of benzodiazepines (midazolam equivalents) was 24mg, and the median daily dose of opioids (fentanyl equivalents) was 3875 μg. There was a moderate negative correlation between the day of ECMO and the median daily benzodiazepine dose (r=-0.5515) and a very weak negative correlation for the median daily opioid dose (r=-0.0053). On average, patients were sedated to Richmond Agitation Sedation Scale scores between 0 and -1. Continuous infusions of opioids, benzodiazepines, propofol, dexmedetomidine, and NMBAs were administered on 404 (85.1%), 199 (41.9%), 95 (20%), 32 (6.7%), and 60 (12.6%) ECMO days, respectively. Patients in the VA arm received a continuous infusion opioid (96.4% vs 81.6% days; P<.001) and benzodiazepine (58.2% vs 37.0% days; P<.001) more frequently.



Patients received relatively low doses of sedatives and analgesics while at a light level of sedation on average. Patients rarely required neuromuscular blockade.
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA. Electronic address: jdegrado@partners.org.
Jeremy R
JR
DeGrado
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
Benjamin
B
Hohlfelder
Department of Pharmacy, Mayo Clinic, Rochester, MN.
Brianne M
BM
Ritchie
Department of Pharmacy, Brigham and Women's Hospital, Boston, MA.
Kevin E
KE
Anger
Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT.
David P
DP
Reardon
Department of Pulmonology, Brigham and Women's Hospital, Boston, MA.
Gerald L
GL
Weinhouse
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D020927:Dexmedetomidine / Q000627:therapeutic use; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies
D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents; D001569:Benzodiazepines; D020927:Dexmedetomidine; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
ECMO; Extracorporeal membrane oxygenation; Intensive care unit; Neuromuscular blockade; PAD; Sedation