Evaluation of Neuromuscular Blocking Agent Utilization in Extracorporeal Membrane Oxygenation

Neuromuscular blocking agent (NMB) utilization has been infrequently described in patients requiring extracorporeal membrane oxygenation (ECMO). The goal of this analysis was to evaluate NMB utilization at a high-volume ECMO center. This was a retrospective cohort study of patients who required ECMO at the Cleveland Clinic between January 2022 and December 2023. NMB utilization was collected, including the agent, dose, duration (if continuous infusion), and indication. Other clinical outcomes recorded included duration of ECMO support, evidence of neuromuscular dysfunction, and hospital mortality. In total, 329 patients were evaluated, and 280 patients were included. Nearly 50% of patients received NMB during their ECMO course. Most utilization was rocuronium bolus. Continuous infusion NMB was only used in 12%. Common indications for NMB were for bedside procedures (66%), hypoxemia (9%), and ECMO low flows (6%). When used for hypoxemia or ECMO low flows, administration of NMB was associated with an improvement in partial pressure of arterial oxygen (PaO2) (64 vs. 105 mm Hg, p < 0.001) and ECMO flow (2.9 vs. 4.0 L/min, p = 0.016) at 1 hour, respectively. Evidence of neuromuscular dysfunction was documented in 6% of patients. Neuromuscular blocking agent use was needed in about half of patients on ECMO, but few patients required continuous NMB.