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A meta-analysis of the opioid antagonist remifentanil versus isoflurane during extracorporeal membrane oxygenation.
To determine whether remifentanil reduces isoflurane requirements in neonates on venoarterial extracorporeal membrane oxygenation (ECMO). PubMed (1966-May 2014) was searched for human studies of normothermic cardiac ECMO using isoflurane versus remifentanil. Primary outcome was isoflurane requirement. Secondary outcomes included duration of isoflurane use, peak end-tidal concentration, duration of mechanical ventilation, duration of ECMO, mortality, and neurological outcomes. A total of 23 studies were included. Inclusion criteria were the use of ECMO, neonates with the same isoflurane fraction in both groups, and data available on the dose of isoflurane and remifentanil. Meta-analysis showed that mean isoflurane use was reduced by 37% during therapy with remifentanil (mean difference in isoflurane use, 0.15 minimum-maximum). Mean isoflurane use was reduced by 18% on the conventional ventilator (mean difference in isoflurane use, 0.09 minimum-maximum). Duration of isoflurane use was reduced by 33% during therapy with remifentanil (mean difference in isoflurane use, 0.22; 95% confidence interval [CI]: 0.17-0.27). Duration of isoflurane use was reduced by 46% when the infant was on the conventional ventilator (mean difference in isoflurane use, 0.32; 95% CI: 0.27-0.37). Duration of isoflurane use was reduced by 34% during ECMO (mean difference in isoflurane use, 0.26; 95% CI: 0.22-0.30). Mortality and neurological outcomes were similar in both groups. There is clear evidence from randomized controlled studies that remifentanil decreases is
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