Comparison of Sedation Requirements in Vv Ecmo Patients with Sars-Cov-2 Versus Non-Sarscov- 2 Ards

ABSTRACT

INTRODUCTION: Increased sedation and analgesia requirements have been described in patients with acute respiratory distress syndrome (ARDS) on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges. The primary objective of this study was to compare analgesia and sedation requirements in adult patients with SARS-CoV-2 ARDS versus other etiologies of ARDS requiring VV-ECMO support. METHOD(S) This was a retrospective cohort study of adult patients requiring VV-ECMO for ARDS between May 2016 and July 2021. Patients were excluded if cannulated at an outside hospital for greater than 24 hours, expired within 48 hours of ECMO cannulation, or received neuromuscular blocking agents for greater than 7 consecutive days. The primary outcome of the study was the daily median dose for continuous infusion analgosedation for 7 days following ECMO cannulation. Secondary outcomes included the daily median analgosedation requirements utilizing the highest daily rate, ICU length of stay and mortality, and incidence of adjunct sedation, analgesia, and anxiolytic use while on VVECMO. RESULT(S) Of 108 patients evaluated on VV-ECMO support, 44 had non-SARS-CoV-2 ARDS and 64 had SARS-CoV-2 ARDS. The median daily dexmedetomidine requirements were significantly higher in the SARS-CoV-2 cohort (16.7 vs. 13.4 mcg/kg/day, p=0.03), while the median propofol daily requirements were significantly higher in the non- SARS-CoV-2 cohort (40.3 vs. 53.5 mg/kg/day, p < 0.01). There was no difference in daily requirements of opioids, benzodiazepines, and ketamine between groups. Patients in the SARS-CoV-2 cohort remained on greater than 2 continuous infusion agents significantly longer than the non-SARS-CoV-2 cohort (3.0 vs. 2.0 days, p=0.04). Use of non-parenteral adjunct agents was significantly higher in the SARS-CoV-2 cohort (78.1% vs. 43.2%, p< 0.01). CONCLUSION(S) Patients with ARDS on VV-ECMO support require multiple analgesic and sedative agents with higher utilization of non-parenteral adjunct agents in the SARSCoV- 2 ARDS cohort. To circumvent these challenges, ECMO centers should consider implementation of ECMO-specific analgosedation protocols to optimize patient outcomes.