Continuous-Infusion Etomidate in a Patient Receiving Extracorporeal Membrane Oxygenation

Area of Science:

• Critical Care Medicine
• Pharmacology
• Extracorporeal Life Support

Background:

• Refractory respiratory failure in a 16-year-old male necessitated extracorporeal membrane oxygenation (ECMO).
• Standard sedation and analgesia failed, requiring exploration of alternative pharmacologic strategies.

Observation:

• Continuous infusion etomidate was initiated for agitation-induced hypertension on ECMO.
• The patient received high-dose etomidate (20 mcg/kg/min) for six days without developing metabolic acidosis, a known side effect.
• An elevated osmolar gap was observed during etomidate therapy, which resolved upon discontinuation.

Findings:

• Etomidate effectively controlled blood pressure and reduced the need for other sedatives during ECMO.
• The absence of metabolic acidosis despite high-dose etomidate suggests a potential protective role of the ECMO circuit.
• Continuous infusion ketamine was less effective in controlling blood pressure.

Implications:

• Continuous infusion etomidate may be a viable option for managing agitation in ECMO patients when other treatments fail.
• Further research is warranted to elucidate the interaction between ECMO and etomidate metabolism, particularly regarding the mitigation of metabolic acidosis.
• This case highlights the complexity of pharmacologic management in critically ill patients on advanced life support.