Pharmacological Considerations for Analgesia and Sedation of ECMO Patients

As the ability to provide extracorporeal membrane oxygenation (ECMO) becomes increasingly available, it will be applied to a variety of clinical contexts in patients with cardiorespiratory failure or for those who may benefit from periprocedural support. Analgesia and sedation are integral to the safe management of these patients in the intensive care unit. As the candidates for ECMO support are heterogeneous, so also must be the strategies for analgesia and sedation. The strategy is first shaped by the clinical context and then the clinical course. Patient comfort, safety, the optimization of physiology, and early rehabilitation are all relevant considerations. Apart from this, the influence of ECMO will alter the pharmacokinetics and pharmacodynamics of selected sedatives and analgesics. This chapter covers the role, considerations, potential options, and implications for analgesia and sedation. The case discussions highlight distinct presentations and incorporate a critical review of the literature. This serves as a concise problem-based learning tool to better understand analgesia and sedation in ECMO.