Abstract
Objective The study aims to describe our experience with the implementation of phenobarbital
as a primary sedation strategy during neonatal extracorporeal membrane oxygenation
(ECMO).
Study Design Retrospective chart review in a level IV neonatal intensive care unit between 2011
and 2021 comparing neonatal ECMO patients before and after the implementation of a
sedation-analgesia (SA) protocol using scheduled phenobarbital as the primary sedative.
Groups were compared for neonatal and ECMO characteristics, cumulative SA doses, and
in-hospital outcomes. Comparison between groups was performed using Mann–Whitney test
on continuous variables and chi-square on nominal variables.
Results Forty-two patients were included, 23 preprotocol and 19 postprotocol. Birth, pre-ECMO,
and ECMO clinical characteristics were similar between groups except for a lower birth
weight in the postprotocol group (p = 0.024). After standardization of phenobarbital SA protocol, there was a statistically
significant reduction in median total morphine dose (31.38–17.65 mg/kg, p = 0.006) and median total midazolam dose (36.21–6.36 mg/kg, p < 0.001). There was also a reduction in median total days on morphine by 7.5 days
(p = 0.026) and midazolam by 6.6 days (p = 0.003). There were no differences in ECMO duration or in-hospital outcomes between
groups.
Conclusion In this cohort, short-term use of phenobarbital as primary sedation strategy during
neonatal ECMO was associated with reduced opioid and midazolam burden. Such reduction,
however, did not affect in-hospital outcomes.
Key Points
-
Prolonged sedation on ECMO puts infants at risk for iatrogenic withdrawal.
-
Phenobarbital is a feasible sedation strategy for ECMO.
-
Phenobarbital sedation strategy may mitigate risk by decreasing opioid and midazolam
burden.
Keywords
infant - neonate - ECMO - sedation strategy - iatrogenic withdrawal - phenobarbital
