Fentanyl Exposure During Extracorporeal Membrane Oxygenation and Association with Methadone Treatment among Pediatric Survivors

Purpose Single-center studies suggest fentanyl use during extracorporeal membrane oxygenation (ECMO) may increase risk of post-ECMO methadone treatment. This study evaluated fentanyl exposure during ECMO and subsequent methadone or buprenorphine treatment among pediatric ECMO survivors. Methods This retrospective study included children < 18y treated at 41 U.S. children’s hospitals in the Pediatric Health Information System between 2016–2023. Multivariable hierarchical regression was used to assess the relationship between fentanyl exposure and likelihood of receiving methadone or buprenorphine and post-ECMO health outcomes, adjusting for covariates including other opioid exposures. Results Overall, 4,365 children were included (55.5% male; 47.9% neonatal). Fentanyl exposure was categorized into quartiles: 0–1 days, 2 days, 3–4 days, and ≥ 5 days. Children in the 3–4 day quartile (OR 1.32; 95% CI: 1.05–1.65) and ≥ 5 day quartile (OR 2.21; 95% CI: 1.71–2.85) were more likely to receive methadone or buprenorphine compared with the 0–1 day quartile. Fentanyl exposure was also associated with prolonged ventilator dependence, TPN use, and post-ECMO length of stay. Conclusion Prolonged fentanyl exposure during ECMO increased risk of methadone or buprenorphine treatment post-ECMO. Our findings underscore the need for opioid stewardship initiatives to minimize fentanyl prescribing and encourage alternative analgesic agents in children on ECMO.