Purpose: In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO. Methods: Prospective observational study in 20 neonates (0.17-5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms. Results: Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0-24.1 h). Median interruption duration for midazolam was 16.5 h (6.6-29.6 h), and for morphine was 11.2 h (6.7-39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred. Conclusions: This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2-3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes.

Daily interruption, Extracorporeal membrane oxygenation, Neonate, Sedation, analgesia, article, artificial ventilation, cannulation, clinical article, cohort analysis, continuous infusion, extracorporeal oxygenation, feasibility study, female, fentanyl, hospital admission, human, infant, male, midazolam, morphine, newborn, observational study, pain assessment, prospective study, sedation, treatment duration, visual analog scale
dx.doi.org/10.1007/s00134-010-1931-4, hdl.handle.net/1765/20855
Intensive Care Medicine
Erasmus MC: University Medical Center Rotterdam

Wildschut, E.D, Hanekamp, M.N, Vet, N.J, Houmes, R.J.M, Ashman, M.J, Mathôt, R.A.A, … Tibboel, D. (2010). Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation. Intensive Care Medicine, 36(9), 1587–1591. doi:10.1007/s00134-010-1931-4