ABSTRACT
Objectives: Analgosedation of patients with severe respiratory failure due to coronavirus disease 2019 (COVID-19) proved to be challenging. Patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO) seemed to require analgosedative drugs in high doses. This study reviews analgosedation practices in patients with COVID-19 associated severe respiratory failure supported with VV ECMO. Method(s): This is a retrospective, single-center registry study including all patients with COVID-19 associated severe respiratory failure that were supported with VV ECMO at our center. All sedative and analgetic drugs administered intravenously or via inhalation to patients for at least two hours were recorded and analyzed. Result(s): Between March 2020 and January 2022, 88 patients with COVID-19 associated severe respiratory failure were supported with VV ECMO at our center. Propofol and sufentanil were used most frequently for analgosedation in this cohort. Both drugs were co-administered following treatment standards established prior to the emergence of COVID-19 at our center. Sedative and analgetic drugs were switched to alternative regimens after a median time of 3 and 12.5 days. Alternative regimens included Isofluran, alpha-2- agonists (clonidine or dextomidine) or esketamine. Alpha-2- agonists were initiated at a median time of 2 days after starting VV ECMO support. Benzodiazepines were used primarily as last resort treatment option for sedation at our center. During the four waves of the pandemic experienced at our center, we experienced an increased average number of drugs needed for analgosedation. Conclusion(s): Analgosedation in critically ill COVID-19 patients supported with ECMO is challenging. It remains unclear, whether the standard analgosedation regimen with sufentanil and propofol established at our center prior to the COVID-19 pandemic is optimal for this patient cohort. Further studies are needed to determine optimal and long term safe analgosedation regimens in critically ill patients supported by VV ECMO. Furthermore, changes experienced during the course of the pandemic need to be scrutinized in comparison to other cohorts. (Table Presented).
ABSTRACT
Introduction: Venovenous extracorpo-real membrane oxygenation (VV ECMO) is an established support option for patients with severe respiratory failure that has been used with increasing frequency throughout the world in recent years. During the coro-navirus disease 2019 (COVID-19) pandemic, ECMO was used for patients with severe COVID-19-associated respiratory failure. We analyzed 90-day survival of all COVID-19 patients supported with VV ECMO for 30 days or longer in our center. Material and methods: Retrospective single-center registry study including all patients with severe respiratory failure associated with SARS-CoV-2 infection, supported with VV ECMO for 30 days or longer. Results: At our center, between March 2020 and January 2022, 29 patients with severe respiratory failure and COVID-19 were supported with VV ECMO for 30 days or longer. 90 days after initia-tion of ECMO, 20/29 patients had survived (69%). Survival to day 90 of patients younger than 50 years (8/8, 100%) was significantly higher than of those older than 50 years (12/21, 57%, p = 0.037). Discussion: Even after prolonged ECMO support for more than 30 days in patients with severe COVID-19-associated respiratory failure, successful weaning from ECMO support is possible in many cases. The duration of previous ECMO support should not be the sole parameter for prognosis in individual patients with severe COVID-19-associated respiratory failure.