.jpg "Renae Gozelski, PharmD photo")
Renae Gozelski, PharmD
PGY2 Critical Care Pharmacy Resident
Virginia Commonwealth University Health System
Richmond, VA
Disclosure information not submitted.
Chelsea Konopka, BCCCP, PharmD
Cardiothoracic Surgical ICU Clinical Pharmacy Specialist
Allegheny General Hospital
Pittsburgh, Pennsylvania, United States
Disclosure information not submitted.
Michael Collins, MD
Surgical Director of Allegheny General Hospital ECMO Program
Allegheny General Hospital, United States
Disclosure information not submitted.
Subbarao Elapavaluru, MD,
Medical Director of Allegheny General Hospital ECMO Program
Allegheny General Hospital, United States
Disclosure information not submitted.
Title: Adjunctive Antipsychotic Agent Use in Veno-venous Extracorporeal Membrane Oxygenation
Introduction: Patients on Veno-venous Extracorporeal Membrane Oxygenation (VV ECMO) for respiratory failure often require sedation with opioids and benzodiazepines (BZD). Due to the adverse effects associated with these medications, adjunctive agents are added to reduce opioid and BZD requirements. The purpose of this study is to determine if the use of adjunctive antipsychotic agents (APA) lowers BZD and opioid requirements, respectively.
Methods: A single-center, retrospective chart review of adult intensive care unit (ICU) patients receiving VV ECMO for at least 48 hours from January 1, 2017 to December 31, 2020 was conducted. Patients who received scheduled adjunctive APA(s) for at least 48 hours while on VV ECMO were compared to those who did not. Patients were excluded if cannulated at an outside hospital, received an APA prior to ECMO, or received a neuromuscular blocking agent during ECMO. Patient demographics and adverse events were collected. Sedation regimens and documented level of sedation were analyzed at pre-defined intervals during ECMO course (48 hours post-cannulation, 24 hours pre and 48 hours post-decannulation, 24 hours pre and 48 hours post-APA initiation).
Results: Of 133 patients screened, 81 were included, with 16 in the adjunctive APA group and 65 in the control group. The APA group had a longer median ECMO duration (12.6 vs. 7.9 days; p = 0.013). There was no statistically significant difference between opioid and BZD requirements. The addition of an adjunctive APA favored a reduction in opioid (12901 to 9898 mcg fentanyl equivalents; p = 0.199, 95% CI [-1686.473, 7691.230]) and BZD (186 to 141 mg midazolam equivalents; p = 0.275, 95% CI [-37.419, 126.123]) requirements. There was a high incidence of deep sedation 24 hours pre-decannulation (87.5 vs. 89.8%; p = 0.789) and 48 hours post-decannulation in both groups (68.8 vs. 62.2%; p = 0.646). There was no incidence of QTc prolongation in the APA group.
Conclusions: Adjunctive antipsychotic agent use did not statistically lower opioid and benzodiazepine requirements in patients on VV ECMO. High incidence of deep sedation throughout ECMO course may have limited the ability to assess the utility of antipsychotic agents.