Level of sedation in patients with COVID-19 supported with ECMO: A comparative analysis of the critical care consortium international database
BackgroundLiberation from sedation may be beneficial for patients with acute respiratory distress syndrome supported by veno-venous (VV) extracorporeal membrane oxygenation (ECMO). Currently, there is limited evidence to support this approach. Therefore, this study aimed to compare the 90-day patient mortality of different sedation strategies in COVID-19 patients supported with VV ECMO.MethodsRetrospective, observational sub-study of the COVID-19 Critical Care Consortium database including COVID-19 patients supported with VV ECMO. Two cohorts were compared: high sedation patients who received neuromuscular blocking agents (NMBAs) throughout ECMO and low sedation patients who did not receive NMBA consistently. Patients' level of sedation during ECMO was also considered. The primary outcome was 90-day in-hospital mortality and was assessed using cause-specific Cox proportional hazard models.Results224 low and 104 high sedation patients were included. Pre-ECMO respiratory condition prior was similar between groups, except for the ratio of partial pressure of oxygen to inspired fraction of oxygen, which was lower in the high sedation group at 93 [61-130] than the low sedation group at 106 [69-140]. No difference was observed in disease severity scores between cohorts. Low sedation patients had longer ECMO runs, more circuit changes, but lower infectious and hemorrhagic complications. Higher sedation was associated with a hazard ratio for death of 3.23 (95% CI 2.16-4.83) compared to low sedation.ConclusionsReduced sedation in COVID-19 ECMO patients is feasible and may be associated with improved survival and reduced complications compared to continuous paralysis, albeit with longer ECMO runs.
Authors
- Jordi Riera (ORCID: https://orcid.org/0000-0002-1738-4448)
- Akram Zaaqoq (ORCID: https://orcid.org/0000-0003-3147-5044)
- Jacky Y. Suen (ORCID: https://orcid.org/0000-0002-0309-2524)
- Giles J. Peek (ORCID: https://orcid.org/0000-0002-1313-6498)
- Marcela Céspedes (ORCID: https://orcid.org/0000-0002-0997-1941)
- Silver Heinsar (ORCID: https://orcid.org/0000-0002-5004-4816)
- Ahmed Labib (ORCID: https://orcid.org/0000-0003-1863-0484)
- Jeffrey Phillip Jacobs (ORCID: https://orcid.org/0000-0002-9916-929X)
- Roberto Lorusso (ORCID: https://orcid.org/0000-0002-1777-2045)
- Hergen Buscher (ORCID: https://orcid.org/0000-0002-4531-6151)
- Muhammad Aftab (ORCID: https://orcid.org/0000-0002-2465-9964)
- Nicole White (ORCID: https://orcid.org/0000-0002-9292-0773)
- Anna Ciullo (ORCID: https://orcid.org/0000-0002-3220-2921)
- Gianluigi Li Bassi (ORCID: https://orcid.org/0000-0002-0816-0880)
- Peta M. A. Alexander
- John F. Fraser
Institutions
- Boston Children's Hospital (US)
- Commonwealth Scientific and Industrial Research Organisation (AU)
- Harvard University (US)
- Queensland University of Technology (AU)
- The University of Queensland (AU)
- University of Utah (US)
- Maastricht University Medical Centre (NL)
- Instituto de Salud Carlos III (ES)
- University of Florida (US)
- St Vincent's Hospital Sydney (AU)
- North Estonia Medical Centre (EE)
- Vall d'Hebron Institut de Recerca (ES)
- Prince Charles Hospital (AU)
- Vall d'Hebron Hospital Universitari (ES)
- Australian e-Health Research Centre (AU)
- Weill Cornell Medical College in Qatar (QA)
- Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES)
- Hamad Medical Corporation (QA)
- University of Virginia (US)
- University of Tartu (EE)
- Universitat de Barcelona (ES)
- University of Colorado Denver (US)
Publication Details
- Journal
- Perfusion
- Published
- 2025-02-26
- DOI
- https://doi.org/10.1177/02676591251324136
- Citations
- 3
- Primary Topic
- Mechanical Circulatory Support Devices
- Type
- article
- Field-Weighted Citation Impact
- 2.02
Funders
- Bill and Melinda Gates Foundation
- University of Queensland
- Prince Charles Hospital Foundation