(1139) Early Versus Late Initiation of Enteral Adjuncts in Venovenous Extracorporeal Membrane Oxygenation

Introduction: Patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO) have been shown to have higher intravenous (IV) sedation requirements and prolonged mechanical ventilation time. Recent literature suggests that early extubation and mobility improve rates of survival to discharge; however, inability to wean IV analgosedation may be a barrier. One potential strategy to decrease IV sedation is use of adjunct enteral sedative, anxiolytic, and analgesic agents, although there is limited data to support their use. The purpose of this study was to assess the impact of early versus late addition of enteral adjunct agents on continuous sedation/analgesic requirements and clinical outcomes in VV-ECMO patients.

Methods: This was a retrospective cohort study comparing early to late (≤72 hours versus >72 hours from time of cannulation) addition of adjunct sedation, anxiolytic, or analgesia agents in VV-ECMO patients. The primary endpoint was time to ≤1 continuous infusion analgosedation agent from ECMO cannulation. Secondary endpoints included time to adjunct initiation, duration of use, characterization of adjunct agents, adverse drug events, IV analgosedation requirements, length of stay, and mortality.

Results: The study included 65 patients in the early group and 62 patients in the late group. There was no significant difference in time to ≤1 continuous infusion analgosedation agent from ECMO cannulation. Incidence of adverse drug events such as QTc prolongation were not shown to be significantly increased between groups. No difference was seen in mechanical ventilation duration; however, those with early initiation of adjuncts were noted to have a shorter intensive care unit (ICU) length of stay.

Conclusions: While early adjunct use did not significantly impact time to weaning of IV sedation, use of some classes of IV agents did trend down after initiation which may suggest that use of these enteral adjuncts for weaning is a reasonable approach. The lack of major safety events and potential benefits seen may also support adjunct use in the ECMO population. Current gaps in formalized protocols suggest that future research is needed to better understand the nuances of adjunct utilization.