J Emily Von Bulow, PharmD
PGY2 Emergency Medicine Pharmacy Resident
n/a
Disclosure information not submitted.
.jpg "Siu Yan Amy Yeung, BCCCP, BCPS, PharmD photo")
Siu Yan Amy Yeung, BCCCP, BCPS, PharmD
Clinical Specialist, MICU
University of Maryland Medical Center
Baltimore, MD
Disclosure information not submitted.
Michael Armahizer, BCCCP, PharmD
Clinical Pharmacy Specialist, Neuro-Critical Care
University of Maryland Medical Center, United States
Disclosure information not submitted.
Sai Ho Chui, PharmD, BCCCP, BCPS
Clinical Pharmacy Specialist, Multi-trauma Unit
University of Maryland School of Pharmacy, United States
Disclosure information not submitted.
Miranda Gibbons
Business Intelligence Developer
University of Maryland School of Medicine, United States
Disclosure information not submitted.
Mehrnaz Pajoumand, PharmD, BCCCP, BCPS
Clinical Pharmacy Specialist, Lung Rescue Unit and Neuro-trauma Unit
University of Maryland Medical Center, United States
Disclosure information not submitted.
.jpg "Ali Tabatabai, MD, photo")
Ali Tabatabai, MD,
Associate Professor
University of Maryland
Baltimore, MD
Disclosure information not submitted.
Megan Anders, MD, MS
Assistant Professor of Anesthesiology
University of Maryland Medical Center, United States
Disclosure information not submitted.
Title: Effect of VV on Sedative Requirements in Patients with Severe ARDS from COVID-19
Introduction: Adequate sedation and analgesia are often required to facilitate mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Changes in volume of distribution and drug sequestration within the ECMO circuit can significantly alter patient exposure to medications. It was observed that patients with COVID-19 have higher sedative requirements. We hypothesized that the use of VV ECMO in critically ill patients with SARS-CoV-2- associated ARDS would result in higher sedation requirements compared to those patients on mechanical ventilation (MV) alone.
Methods: This was a single center, retrospective, case-control study of patients with confirmed SARS-CoV-2 infection receiving VV-ECMO + MV or MV alone from March 1, 2020 to September 30, 2020. Patients were included if transferred to our institution on MV, or intubated and cannulated within 24 hours of admission. Patients were excluded if they were on MV for >7 days or cannulated prior to transfer, died within 7 days of admission, or decannulation or extubation occurred within 7 days of admission. The primary outcome was the 7-day sedative exposure in midazolam equivalents. Secondary outcomes included 7-day analgesia exposure in morphine equivalents, depth of sedation, hospital length of stay (LOS) and survival to discharge.
Results: A total of 49 patients were evaluated, 25 on VV-ECMO and MV and 24 on MV alone. When comparing patients on VV-ECMO and MV to MV alone, there was no difference in sedative exposure (1767.7 mg vs 1574.1, p=0.37) or analgesia exposure (488.6 mg vs 279.1, p=0.24). Patients in the VV-ECMO and mechanical ventilation group had higher use of midazolam (68% vs 29.2%) and rocuronium (96% vs 62.5%). Patients on VV-ECMO and MV had deeper sedation target (RASS -4 vs -3, p < 0.001), had a longer ICU LOS (39.7 days vs 19.6, p < 0.001) and longer hospital LOS (41.9 days vs 31.4, p=0.03). No difference in survival to discharge was observed between groups (60% vs 79%, p=0.15).Younger age, higher weight and BMI, and lower Charlson comorbidity index were associated with higher sedation requirements, but not receipt of VV-ECMO.
Conclusion: No significant difference in sedative and analgesic requirements were observed in patients with COVID-19 on VV-ECMO. Patients on VV-ECMO had deeper target sedation level with longer ICU and hospital LOS.