Indian Journal of ECMO

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 1 , ISSUE 3-4 ( July-December, 2023 ) > List of Articles


Sedation Practices during VV-ECMO in Indian Scenario: A Retrospective Survey

Vikrant Shamrao Pawar

Keywords : Sedation, Survey, Venovenous extracorporeal membrane oxygenation

Citation Information : Pawar VS. Sedation Practices during VV-ECMO in Indian Scenario: A Retrospective Survey. Indian J ECMO 2023; 1 (3-4):99-103.

DOI: 10.5005/jaypee-journals-11011-0022

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Aim and background: There has been an exponential rise in the use of venovenous extracorporeal membrane (VV-ECMO) in patients who develop acute respiratory distress syndrome (ARDS), as observed in Indian hospitals. In spite of the ever-increasing cases of patients being treated with VV-ECMO, there is scarcity of literature about sedation management in this patient group. This retrospective, online questionnaire-based survey was undertaken with an aim of gaining an overview of what majority institutes in India are practicing with respect to sedation during VV-ECMO, so that it can contribute to the smallest extent in forming policies and protocols. Materials and methods: This survey was formulated on SurveyMonkey application and shared with members of ECMO society of India (ESOI) through WhatsApp. Their responses were recorded and analyzed through SurveyMonkey application. Results: Fentanyl was found to be the most widely used drug followed by midazolam and fentanyl plus midazolam was the most commonly used combination. Majority of participants (83.33%) use Richmond Agitation-Sedation Scale (RASS) for monitoring agitation. Only other scale being used is the Ramsay scale. Incidence of delirium was less than 10% in most intensive care units (ICUs). Majority of participants (54.17%) required deep sedation for less than 5 days to keep their patients calm and comfortable. Physiotherapy was given during both deep and light sedation in most of the units (60%). Conclusion: We found substantial uniformity with respect to choice of agitation scales used, initiation of physiotherapy, incidence of delirium and number of days on deep sedation among the centers across India. Clinical significance: Although this survey gives a glimpse of sedation practices in VV-ECMO in many centers across India, more surveys and studies are required on this topic.

  1. Brogan TV, Lequier L, Lorusso R, et al. Extracorporeal Life Support: The ELSO Red Book. In: Brogan TV. (Ed). Ann Arbor (MI), USA: Extracorporeal Life Support Organization; 2017. p. 868.
  2. Pavlushkov E, Berman M, Valchanov K. Cannulation techniques for extracorporeal life support. Ann Transl Med 2017;5(4):70. DOI: 10.21037/atm.2016.11.47.
  3. Sangalli F, Nicolo P, Pesenti A. ECMO-extracorporeal life support in adults. In: Sangalli F. (Ed). Milan (MI): Springer-Verlag Mailand; 2014.
  4. Custer JR. The evolution of patient selection criteria and indications for extracorporeal life support in pediatric cardiopulmonary failure: Next time, let's not eat the bones. Organogenesis 2011;7(1):13–22. DOI: 10.4161/org.7.1.14024.
  5. Vyas A, Bishop MA. Extracorporeal Membrane Oxygenation in Adults. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 35015451.
  6. Wrisinger WC, Thompson SL. Basics of extracorporeal membrane oxygenation. Surg Clin North Am 2022;102(1):23–35. DOI: 10.1016/j.suc.2021.09.001.
  7. Brodie D., Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA 2019;322(6):557–568. DOI: 10.1001/jama.2019.9302.
  8. deBacker J, Tamberg E, Munshi L, et al. Sedation practice in extracorporeal membrane oxygenation-treated patients with acute respiratory distress syndrome: A retrospective study. ASAIO J 2018;64(4):544–551. DOI: 10.1097/MAT.0000000000000658.
  9. Buscher H, Vaidiyanathan S, Al-Soufi S, et al. Sedation practice in veno-venous extracorporeal membrane oxygenation: An international survey. ASAIO J 2013;59(6):636–641. DOI: 10.1097/MAT.0b013e3182a84558.
  10. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41(1):263–306. DOI: 10.1097/CCM.0b013e3182783b72.
  11. Xing XZ, Gao Y, Wang HJ, et al. Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency. World J Emerg Med 2015;6(2):147–152. DOI: 10.5847/wjem.j.1920-8642.2015.02.011.
  12. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the Intensive Care Unit on hospital length of stay. Intensive Care Med 2001;27(12):1892–1900. DOI: 10.1007/s00134-001-1132-2.
  13. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet 2009;373(9678):1874–1882. DOI: 10.1016/S0140-6736(09)60658-9.
  14. Dzierba AL, Abrams D, Madahar P, et al. Current practice and perceptions regarding pain, agitation and delirium management in patients receiving veno-venous extracorporeal membrane oxygenation. J Crit Care 2019;53(10):98–106. DOI: 10.1016/j.jcrc.2019. 05.014.
  15. DeGrado JR, Hohlfelder B, Ritchie BM, et al. Evaluation of sedatives, analgesics, and neuromuscular blocking agents in adults receiving extracorporeal membrane oxygenation. J Crit Care 2017;37(2):1–6. DOI: 10.1016/j.jcrc.2016.07.020.
  16. Shekar K, Fraser JF, Smith MT, et al. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care 2012;27(6):741.e9–18. DOI: 10.1016/j.jcrc.2012.02.013.
  17. Cheng V, Abdul-Haziz MH, Roberts JA, et al. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J Thorac Dis 2018;10(Suppl 5):S629–S641. DOI: 10.21037/jtd.2017.09.154.
  18. Millar JE, Fanning JP, McDonald CI, et al. The inflammatory response to extracorporeal membrane oxygenation (ECMO): A review of the pathophysiology. Crit Care 2016;20(1):387. DOI: 10.1186/s13054-016-1570-4.
  19. Romera-Ortega MA, Chamorro-Jambrina C. Analgo-sedation strategies in patients with ECMO. Med Intensiva (Engl Ed). 2023;47(3):165–169. DOI: 10.1016/j.medine.2022.10.013.
  20. Marhong JD, DeBacker J, Viau-Lapointe J, et al. Sedation and mobilization during venovenous extracorporeal membrane oxygenation for acute respiratory failure: An international survey. Crit Care Med 2017;45(11):1893–1899. DOI: 10.1097/CCM.0000000000002702.
  21. Extracorporeal Life Support Organization (ELSO) General Guidelines for all ECLS Cases: Extracorporeal Life Support Organization Web. Available at:
  22. Bonizzoli M, Lazzeri C, Drago A, et al. Effects of a physiotherapic program in patients on veno-venous extracorporeal membrane oxygenation: An 8-year single-center experience. Minerva Anestesiol 2019;85(9):989–994. DOI: 10.23736/S0375-9393.19.13287-7.
  23. Munshi L, Kobayashi T, DeBacker J, et al. Intensive care physiotherapy during extracorporeal membrane oxygenation for acute respiratory distress syndrome. Ann Am Thorac Soc 2017;14(2):246–253. DOI: 10.1513/AnnalsATS.201606-484OC.
  24. Ho MH, Lee JJ, Lai PCK, et al. Prevalence of delirium among critically ill patients who received extracorporeal membrane oxygenation therapy: A systematic review and proportional meta-analysis. Intensive Crit Care Nurs 2023;79:103498. DOI: 10.1016/j.iccn.2023.103498.
  25. Minnen OV, Jolink FEJ, Van den Bergh WM, et al. International survey on mechanical ventilation during extracorporeal membrane oxygenation. ASAIO J 2023. DOI: 10.1097/MAT.0000000000002101.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.