• Irina Timofte, Michael Terrin, Erik Barr, June Kim, Joseph Rinaldi, Nicholas Ladikos, Jay Menaker, Ali Tabatabai, Zachary Kon, Bartley Griffith, Richard Pierson, Si Pham, Aldo Iacono, and Daniel Herr.
• Department of Medicine, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD, United States. Electronic address: IrTimofte@SOM.umaryland.edu.
• J Crit Care. 2017 Dec 1; 42: 157-161.

PurposeSedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy.MethodsWe reviewed data on 3 ECMO patients for whom we used a novel approach to replace continuous drips with periodic sedation/paralysis. Initially our patients were on high dose narcotics, propofol, and dexmedetomidine and unable to interact and breathe comfortably. IV narcotics were weaned over 24h and were replaced by methadone. Dexmedetomidine was continued in order to block hyperadrenergic events. Propofol was weaned at a prescribed rate. When patients demonstrated agitation, decreased pump flow and hemodynamic compromise, diazepam was given in combination with a paralytic.ResultsBy replacing IV narcotic and propofol, with PRN diazepam and vecuronium, patients were off continuous drips in 1week and were able to actively participate in physical therapy.ConclusionAllowing patients to wake up by rapid weaning of continuous narcotics and anesthetic agents using Dexmedetomidine and periodic paralysis to favorably alter hemodynamics is a successful method to wean deep sedation in ECMO.Copyright © 2017 Elsevier Inc. All rights reserved.

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