3RD BEACH Course - Session 3

3RD BEACH Course - Session 3

Sedation and analgesia during ECMO (M Raes)

Picture 5


ELSO guidelines suggest moderate to heavy sedation in the first 24 hours

“Awake” extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering

Current practice and perceptions regarding pain, agitation and delirium management in patients receiving venovenous extracorporeal membrane oxygenation.

Medicating patients during extracorporeal membrane oxygenation: the evidence is building

Volatile sedation in the intensive care unit A systematic review and meta-analysis

Inhalative sedation with small tidal volumes under venovenous ECMO.



  1. Do we need to sedate our ECMO patient?
  • Not all patients
  • Perhaps ‘less’ is ‘more’
  • Major clinical challenge (especially in VV-ECMO)
  • Scarce data
  1. What is the best sedation strategy?
  • No consensus
  • Sequestration on ECMO needs higher doses in most drugs
  • Inhaled anesthetics promising alternative?
  1. Should we monitor?
  • YES!

Weaning from ECMO (D dos Reis Miranda)


When to do wean trial?

  • FiO2 < 60%
  • Vt 4-6 ml/kg
  • Driving pressure < 15 mbar
  • PEEP < 15 mbar


Decrease blood flow 

  • Approx. 1 l/min for LV failure

  • Approx. 0.5 l/min for RV failure

Functional evaluation of sublingual microcirculation indicates successful weaning from VA-ECMO in cardiogenic shock.




  • Do not decrease ECMO blood flow
  • Set ECMO gasflow off at reasonable vent setting
  • Maintain this for couple of hours (practical: overnight)


  • Do not decrease ECMO gasflow
  • Set reasonable vent setting
  • Decrease ECMObloodflow to 0.5 - 1.0 liter/min for 5-15 min
  • Do not solely rely on macrohemodynamic parameters
  • Use echo or microcirculation

Leave a comment

You are commenting as guest.

Social Media

  like us on Facebook

  follow us on Twitter

  join Discussion group

  join us on Linkedin

  newsletter sign up

  post on the blog