Analgesia, sedation, and mobilization practices in pediatric patients supported with extracorporeal membrane oxygenation across Europe: an ESPNIC survey.
Appropriate analgosedation and mobilization are essential elements of care in critically ill children. On extracorporeal membrane oxygenation (ECMO), analgosedation and mobilization are tailored to individual pharmacokinetics and mobilization risks. We aimed to investigate analgo
- Authors
- Cavagnero F, Hoskote A, Lillie J, Morin L, Neunhoeffer F
- Journal
- European journal of pediatrics
- Published
- 2026-08-01
- DOI
- 10.1007/s00431-026-07326-2
- PMID
- 42613392
- Content type
- Paper
- Relation to the core question
- Adjacent. Real psychedelic literature that does not bear on whether independent observers report the same forms. Most of this bibliography is adjacent, and that is not a criticism of the source.
- Authority
- Academic
Abstract
Appropriate analgosedation and mobilization are essential elements of care in critically ill children. On extracorporeal membrane oxygenation (ECMO), analgosedation and mobilization are tailored to individual pharmacokinetics and mobilization risks. We aimed to investigate analgosedation and mobilization practices in pediatric ECMO across Europe. We performed a multicenter cross-sectional survey-based study. We surveyed one experienced physician per pediatric ECMO center in Europe (March-July 2025). Additionally, we investigated differences in practices based on ECMO volume (≤ 10 vs > 10 cases/year) and ICU type (exclusively pediatric ICU vs other ICUs). Among 123 ECMO centers, 96 (77%) responded, across 19 countries. Fifty-two percent of centers managed > 10 ECMO/year; 68% had exclusively pediatric ICUs. Nineteen percent of centers had a dedicated ECMO-analgosedation protocol. Most centers applied the same analgesic (81%) and sedative (80%) strategies used for non-ECMO patients, though higher doses were often reached on ECMO (62%). Morphine and fentanyl were the preferred first-line analgesics, with fentanyl more used in exclusively pediatric ICUs (p = 0.013); midazolam was the preferred first-line sedative (61%) followed by dexmedetomidine (24%); dexmedetomidine, propofol, and ketamine were the most used second- and third-line agents. Analgosedation, iatrogenic withdrawal, and delirium monitoring tools were widely used, yet 16% and 26% of centers did not use any iatrogenic withdrawal syndrome or delirium tools, respectively. Eighty-one percent of centers implemented mobilization; higher ECMO-volume centers implemented mobilization (p = 0.022), awake-ECMO strategies (p = 0.041), and proning (p = 0.009) more frequently compared to lower ECMO-volume centers.
Topics
- ketamine
Citation
Cavagnero F, Hoskote A, Lillie J, Morin L, Neunhoeffer F (2026) Analgesia, sedation, and mobilization practices in pediatric patients supported with extracorporeal membrane oxygenation across Europe: an ESPNIC survey.. European journal of pediatrics. doi:10.1007/s00431-026-07326-2
DOI: 10.1007/s00431-026-07326-2
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