Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

Intensive Care Med. 2010 Sep;36(9):1587-91. doi: 10.1007/s00134-010-1931-4. Epub 2010 May 28.


Purpose: In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO.

Methods: Prospective observational study in 20 neonates (0.17-5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms.

Results: Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0-24.1 h). Median interruption duration for midazolam was 16.5 h (6.6-29.6 h), and for morphine was 11.2 h (6.7-39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred.

Conclusions: This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2-3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes.

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Cardiac Surgical Procedures
  • Cardiopulmonary Bypass
  • Catheterization / methods*
  • Consciousness Monitors
  • Critical Care / methods
  • Dose-Response Relationship, Drug
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Infant, Newborn
  • Infant, Newborn, Diseases / therapy*
  • Intensive Care Units, Neonatal
  • Midazolam / administration & dosage*
  • Morphine / administration & dosage*
  • Neurologic Examination
  • Prospective Studies
  • Treatment Outcome


  • Analgesics, Opioid
  • Hypnotics and Sedatives
  • Morphine
  • Midazolam