Evaluation of sedatives, analgesics, and neuromuscular blocking agents in adults receiving extracorporeal membrane oxygenation

Medicating patients during extracorporeal membrane oxygenation: the evidence is building

“…Additionally, patients receiving venovenous ECMO had a significantly higher daily midazolam dose requirement than did patients receiving venoarterial ECMO ( p  = 0.005) [21]. A more recent single‐center, prospective cohort study set out to determine the median daily dose of opioids and benzodiazepines in 32 patients receiving either venovenous or venoarterial ECMO [22]. In this mixed cohort the median daily dose of opioids and benzodiazepines, 3875 micrograms and 24 mg respectively, was found to be lower than that reported from previous trials.…”

“…Additionally, the authors did not find increasing requirements throughout the duration of ECMO support. The lower opioid and benzodiazepine requirements observed in this study could be a result of the study institution’s analgosedation approach, lower goal sedation scores, and use of other non‐benzodiazepine sedatives [22]. …”

Medicating Patients During Extracorporeal Membrane Oxygenation: The Evidence is Building

“…Additionally, the authors did not find increasing requirements throughout the duration of ECMO support. The lower opioid and benzodiazepine requirements observed in this study could be a result of the study institution's analgosedation approach, lower goal sedation scores, and use of other non-benzodiazepine sedatives [22]. The only comparative trial to date is a recent retrospective cohort study that enrolled consecutive adult patients with severe respiratory failure with (n = 34) or without (n = 60) venovenous ECMO support requiring at least one sedative to maintain a level of wakefulness appropriate to maintain patient comfort and safety while optimizing oxygenation and ventilator support [23].…”

“…Additionally, patients receiving venovenous ECMO had a significantly higher daily midazolam dose requirement than did patients receiving venoarterial ECMO (p = 0.005) [21]. A more recent single-center, prospective cohort study set out to determine the median daily dose of opioids and benzodiazepines in 32 patients receiving either venovenous or venoarterial ECMO [22]. In this mixed cohort the median daily dose of opioids and benzodiazepines, 3875 micrograms and 24 mg respectively, was found to be lower than that reported from previous trials.…”

Ventilatory and Pharmacotherapeutic Strategies for Management of Adult Patients on Extracorporeal Life Support

“…Although remifentanil has a lower log p value than fentanyl, its high protein binding makes this drug susceptible to sequestration within the ECLS circuit. Clinically, higher opioid requirements were observed in small retrospective studies . The first study to describe opioid and sedative requirements in patients receiving ECLS observed an average daily increase in morphine requirement by 29 mg, although no significant increase was noted in fentanyl requirements .…”