Early versus late addition of enteral analgesia and sedation adjuncts in patients on veno-venous extracorporeal membrane oxygenation

Purpose: Patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) have shown to have higher intravenous (IV) sedation requirements and prolonged mechanical ventilation (MV) time. Literature suggests that early extubation and mobility improve survival; however, inability to wean IV analgosedation is a barrier. A strategy to decrease IV sedation is the use of adjunct enteral sedative, anxiolytic, and analgesic agents, although there is limited supportive data. The objective of this study was to assess the impact of early versus late (⩽72 h vs >72 h from time of cannulation) addition of enteral adjunct agents on continuous sedation/analgesic requirements in VV ECMO patients. Major findings: The study included 61 patients in the early group and 59 patients in the late. There was no difference in the primary outcome of time to ⩽1 continuous infusion analgosedation agent from ECMO cannulation. Incidence of adverse drug events were not shown to be increased between groups. No difference was seen in MV duration; however, early initiation of adjuncts resulted in a shorter intensive care unit length of stay. Conclusion: While early adjunct use did not impact weaning of IV sedation, the lack of major safety events and potential benefits seen may support adjunct use in this patient population.