{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T15:12:05Z","timestamp":1789398725692,"version":"build-2803163510"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T00:00:00Z","timestamp":1684972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used in patients with COVID-19 acute respiratory distress syndrome (ARDS). We aim to assess the characteristics of delirium and describe its association with sedation and in-hospital mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed adult patients on VV-ECMO for severe COVID-19 ARDS in the Johns Hopkins Hospital ECMO registry in 2020\u20132021. Delirium was assessed by the Confusion Assessment Method for the ICU (CAM-ICU) when patients scored\u22123 or above on the Richmond Agitation-Sedation Scale (RASS). Primary outcomes were delirium prevalence and duration in the proportion of days on VV-ECMO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 47 patients (median age = 51), 6 were in a persistent coma and 40 of the remaining 41 patients (98%) had ICU delirium. Delirium in the survivors (<jats:italic>n<\/jats:italic> = 21) and non-survivors (<jats:italic>n<\/jats:italic> = 26) was first detected at a similar time point (VV-ECMO day 9.5(5,14) vs. 8.5(5,21), <jats:italic>p<\/jats:italic> = 0.56) with similar total delirium days on VV-ECMO (9.5[3.3, 16.8] vs. 9.0[4.3, 28.3] days, <jats:italic>p<\/jats:italic> = 0.43). Non-survivors had numerically lower RASS scores on VV-ECMO days (\u22123.72[\u22124.42, \u22122.96] vs. \u22123.10[\u22123.91, \u22122.21], <jats:italic>p<\/jats:italic> = 0.06) and significantly prolonged delirium-unassessable days on VV-ECMO with a RASS of \u22124\/\u22125 (23.0[16.3, 38.3] vs. 17.0(6,23), <jats:italic>p<\/jats:italic> = 0.03), and total VV-ECMO days (44.5[20.5, 74.3] vs. 27.0[21, 38], <jats:italic>p<\/jats:italic> = 0.04). The proportion of delirium-present days correlated with RASS (r = 0.64, <jats:italic>p<\/jats:italic> &amp;lt; 0.001), the proportions of days on VV-ECMO with a neuromuscular blocker (r = \u22120.59, <jats:italic>p<\/jats:italic> = 0.001), and with delirium-unassessable exams (r = \u22120.69, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) but not with overall ECMO duration (r = 0.01, <jats:italic>p<\/jats:italic> = 0.96). The average daily dosage of delirium-related medications on ECMO days did not differ significantly. On an exploratory multivariable logistic regression, the proportion of delirium days was not associated with mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Longer duration of delirium was associated with lighter sedation and shorter paralysis, but it did not discern in-hospital mortality. Future studies should evaluate analgosedation and paralytic strategies to optimize delirium, sedation level, and outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2023.1172063","type":"journal-article","created":{"date-parts":[[2023,5,25]],"date-time":"2023-05-25T04:40:56Z","timestamp":1684989656000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation"],"prefix":"10.3389","volume":"10","author":[{"given":"Philip 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