Sedation & Mobilization during Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) for Acute Respiratory Failure: An International Survey
CCCF ePoster library. deBacker J. Nov 1, 2016; 150945; 65
Julian deBacker
Julian deBacker
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Topic: Survey or Interview (quantitative or qualitative)

Sedation & Mobilization during Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO) for Acute Respiratory Failure: An International Survey


Marhong, Jonathan D. MD FRCPC1, DeBacker, Julian MSc2, Munshi, Laveena MD FRCPC3, Del Sorbo, Lorenzo MD1, Burry, Lisa PharmD4, Fan, Eddy MD PhD1, Mehta, Sangeeta MD FRCPC3

1Department of Medicine and Interdepartmental Division of Critical Care Medicine, University Health Network  and University of Toronto, Toronto, Canada,
2Cleveland Clinic Foundation, Cleveland, USA, 
3Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Canada
4Department of Pharmacy and Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Canada
 


Grant acknowledgements:
Physicians’ Services Incorporated Resident Research Grant

Abstract:

Introduction: For patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe acute respiratory failure (ARF), there are no evidence-based guidelines for sedation, analgesia, neuromuscular blockade (NMB), and mobilization.
Objective: This study aimed to characterize these practices in children and adults treated with VV-ECMO for ARF at various centers internationally
Methods: We conducted an international cross-sectional survey of medical directors and program coordinators at 394 ECMO centers registered with the Extracorporeal Life Support Organization (ELSO). The electronic survey was distributed between January 15, 2016 and March 15, 2016. Weekly reminders were sent for the duration of the study period.
Results: We received 209 responses from 394 ECMO centers (53% response rate). Sixty-three % of respondents were from academic centers. Forty-one % of participating centers provide VV-ECMO for adults only, while 22% provide VV-ECMO exclusively to children. The most frequently used opioids are fentanyl (44%; 89/202 respondents) and morphine (29%; 55/189); and the most frequently used sedative agents are midazolam (48%; 97/201) and propofol (19%; 37/196). Fifty-nine % (138/234) of centers aim to have their patients 'sedated' or 'very sedated' while on VV-ECMO. Fifty-one % (102/200 respondents) of centers perform daily sedative/opioid interruption, and 39% (78/202) use a protocol to guide sedation and analgesia practice. Most respondents (118/201, 58%) reported using NMB in ≤25% patients supported on VV-ECMO, for ≤48 hours (52%; 121/232). The most commonly reported approaches to treating delirium are family presence (54%; 97/181) followed by verbal re-orientation (41%; 75/182) and environmental modification (39%; 72/183). Of the 95 respondents who reported that VV-ECMO patients participate in physical therapy, 53 (56%) stated that these patients were mobilized between 24 and 72 hours after cannulation.
Conclusion: Sedation, analgesia, NMB, and mobilization practices in patients supported by VV-ECMO vary across ELSO centers internationally. The majority of centers target moderate sedation during VV-ECMO, and a minority of centers mobilize these patients.
 


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