Objectives (Background): Neither the feasibility nor the cardio- and vasodepressive effects of isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock have been investigated yet.

Design: Retrospective single-center study

Setting: Munich university hospital’s cardiac intensive care unit

Patients/subjects: All cardiogenic shock patients treated with VA-ECMO undergoing volatile sedation with isoflurane between November 2018 and October 2019 were matched by propensity score in a 1:1 ratio with intravenously sedated patients treated between January 2013 and November 2018. Data from the cardiogenic shock registry of the University Hospital of Munich were used to analyze clinical endpoints of patients.

Measurements and Main Results: Thirty-two patients in our registry, treated with VA-ECMO, were sedated with isoflurane. The mean age of patients was 58.4 years for conventional sedation and 56.3 years for isoflurane sedation (p=0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86.1% versus 32.1%, p=0.01). Mean systolic arterial pressure was similar (94.3 mmHg versus 92.9 mmHg, p=0.65), but mean heart rate was significantly higher in the conventional sedation group in contrast to the isoflurane group (85.2/min versus 74.7/min; p=0.02). Importantly, catecholamine dose, VA-ECMO blood flow and VA-ECMO gas flow during the first five days, ventilation time of survivors (304 hours versus 398 hours, p=0.16), bleeding complications and mortality were similar in both groups.
 
Conclusions: Volatile sedation with isoflurane is feasible in patients with cardiogenic shock and VA-ECMO treatment and was not associated with a higher catecholamine dosage and ECMO flow rate. However, differences between isoflurane and intravenous sedation might not be unveiled due to small patient size.