Sedation practice in veno-venous extracorporeal membrane oxygenation: an international survey

Sedation practice in extracorporeal membrane oxygenation (ECMO) is challenging, and some studies suggest that pharmacokinetics of sedative drugs are altered by the circuitry components. We conducted an international survey of sedation practice in centers offering veno-venous ECMO for adult patients in collaboration with the Extracorporeal Life Support Organization. A total 102 respondents participated representing various experienced centers from around the world. Fifty-eight percent responded that patients on ECMO have a higher or much higher sedation requirement than other critically ill patients, whilst 51% achieved a responsive or cooperative level of sedation. Midazolam (79%), morphine (43%) and fentanyl (45%) were most frequently used. Alpha-2 agonists were prescribed in 66% while propofol was used infrequently (36%). Thirty-five percent did not use continuous muscle relaxants. Responses from experienced users differed to those who reported less experience. Sedation practice in ECMO varies widely. Cooperative or responsive levels of sedation can frequently be achieved, and the drugs used differ from those used in non-ECMO patients.