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Institutional Variation in Fentanyl Use for Children on Extracorporeal Membrane Oxygenation

Rabab M Barq1,2, Shadassa Ourshalimian1, Olivia A Keane1,2

  • 1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.

Hospital Pediatrics
|December 17, 2025
PubMed

Insights

Fentanyl is commonly used for critically ill children on extracorporeal membrane oxygenation (ECMO), despite risks. Neonates and children with cardiovascular disease show higher fentanyl use, highlighting the need for better pain management guidelines.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Neonatology

Background:

  • Fentanyl, an opioid analgesic, is frequently used for pain management in critically ill children.
  • Its use during extracorporeal membrane oxygenation (ECMO) is cautioned against due to lipophilic properties increasing withdrawal risks.
  • Understanding institutional variation in fentanyl use for pediatric ECMO patients is crucial.

Purpose of the Study:

  • To evaluate institutional variations in fentanyl administration for children undergoing ECMO.
  • To identify factors associated with fentanyl prescribing patterns in this vulnerable population.

Main Methods:

  • Retrospective study of children (<18 years) on ECMO from 2016-2023.
  • Data sourced from the Pediatric Health Information System.
  • Multivariable hierarchical logistic regression analyzed factors linked to fentanyl use.

Main Results:

  • 91.9% of 7731 children received fentanyl during ECMO, with significant institutional variability (13.4%-100%).
  • Hospital differences accounted for 20.3% of variation in fentanyl use.
  • Neonates (OR 2.35) and children with cardiovascular disease (OR 1.63) had higher odds of fentanyl use; premature infants had lower odds (OR 0.50).

Conclusions:

  • Fentanyl remains prevalent in pediatric ECMO despite recognized risks.
  • Significant institutional variation in fentanyl use exists, with neonates being most exposed.
  • Enhanced guidelines for sedation and pain management in pediatric ECMO are urgently needed.
Abstract

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