182: POST-DECANNULATION ANALGOSEDATION WEANING IN COVID-19 EXTRACORPOREAL MEMBRANE OXYGENATION PATIENTS

Abstract

Introduction: COVID-19-associated acute respiratory distress syndrome (ARDS) has necessitated the use of extracorporeal membrane oxygenation (ECMO) to support patients with impaired respiratory function. Reports of increased analgosedation requirements in COVID-19 patients receiving ECMO highlight the possible challenges of weaning analgesia and sedation once these patients are decannulated. Methods: This retrospective cohort analysis investigated analgesia and sedation requirements in COVID-19 and non-COVID-19 patients after venovenous (VV) or venopulmonary artery (VPa) ECMO decannulation. The primary outcome was time to weaning of parental analgosedation. Secondary objectives included incidence of enteral analgosedative use to facilitate weaning of parenteral agents, discharge analgesia and sedative prescribing patterns, and incidence of weaning failure. Results: A total of 58 patients were included; 32 COVID-19 ECMO and 26 non-COVID-19 ECMO patients. There was a higher incidence of prolonged weaning post-decannulation in the COVID-19 group compared to the non-COVID-19 group (59.4% vs. 46.2%, P = 0.43). The median (IQR) time to weaning of all parenteral agents was 8 days (4-13) in the COVID-19 group and 6 days (2-10) in the non-COVID-19 group (P = 0.32). Of all agents, median duration to wean dexmedetomidine was longest in both the COVID-19 and non-COVID-19 groups [9.25 days (3.75-13); 4.75 days (2-6.75) (P = 0.15)]. COVID-19 patients had a higher incidence of antipsychotic use to facilitate weaning (88% vs. 65%, P = 0.06) and prescription on discharge (47% vs. 27%, P = 0.17). Approximately 19% of patients in each group experienced failure to wean parenteral analgosedation and required re-initiation of parenteral agents during the post-decannulation period. Conclusions: Weaning of analgosedation was longer in COVID-19 ECMO patients following decannulation. COVID-19 ECMO patients also required greater addition of enteral therapies to manage analgesia and sedation in the post-decannulation period. Future studies are needed to investigate strategies to optimize sedation in these patients.