Impact of Dexmedetomidine Sedation on Mortality and Long-term Outcomes in ECMO Patients: A Retrospective Cohort Study

Background We conducted this retrospective cohort study to assess the relationship between dexmedetomidine sedation and in-hospital mortality with 1-year functional outcomes in patients receiving extracorporeal membrane oxygenation (ECMO) support. Methods This retrospective cohort study analyzed patients receiving ≥ 24 hours of ECMO support with sedation requirements in the Intensive Care Unit of the First Affiliated Hospital of Anhui Medical University from May 2018 to February 2022. Exclusion criteria consisted of (1) moribund status, (2) pre-transplant organ maintenance therapy, (3) mortality within 24 hours of ECMO initiation, and (4) external hospital cannulation duration exceeding 24 hours. Results The final analysis included 154 patients: 82 on venovenous ECMO (VV-ECMO) and 72 on venoarterial ECMO (VA-ECMO). Participants were categorized into dexmedetomidine (DEX)-exposed (n = 73) and non-DEX (n = 81) groups. The DEX group showed significantly lower 28-day mortality (p < 0.05), reduced norepinephrine requirements [median 0.12 vs 0.21 µg/(kg·min), p = 0.003], higher ECMO weaning success rate (68.5% vs 51.9%, p = 0.02), and better caloric goal attainment within 7 days (76.7% vs 61.7%, p = 0.04). In the 1-year follow-up of 57 survivors, DEX-treated patients demonstrated lower Anxiety and Depression Scale scores (6.2 ± 2.1 vs 8.7 ± 3.0, p = 0.01; 5.8 ± 1.9 vs 7.9 ± 2.5, p = 0.02), Higher Telephone Interview for Cognitive Status scores (32.4 ± 3.2 vs 29.1 ± 4.1, p = 0.03), improved Pittsburgh Sleep Quality Index (5.2 ± 1.8 vs 7.6 ± 2.3, p < 0.01), and enhanced Quality of Life scores (78.3 ± 6.5 vs 69.2 ± 8.1, p = 0.002). Conclutions : Dexmedetomidine exposure was associated with improved 28-day survival and better long-term neurocognitive outcomes in this ECMO cohort. Due to the retrospective nature of this study, these associations require confirmation in prospective randomized trials.