{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:17:10Z","timestamp":1787026630678,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Recent meta-analyses have established the overall safety of remimazolam in general surgical populations, but evidence in high-risk subgroups such as patients requiring extracorporeal membrane oxygenation (ECMO) remains absent. This study aimed to compare the sedative effects of remimazolam-based vs. midazolam-based sedation regimens in adults requiring ECMO, with a focus on the incidence of delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective study included patients receiving ECMO from January 2023 to October 2025. The primary analysis cohort comprised patients receiving veno-arterial ECMO (VA-ECMO,\n                      <jats:italic>n<\/jats:italic>\n                      = 44), divided into a remimazolam group (Group R\n                      <jats:italic>, n<\/jats:italic>\n                      = 22) or a midazolam group (Group M,\n                      <jats:italic>n<\/jats:italic>\n                      = 22). The primary outcome was delirium incidence assessed by the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For the primary outcome, delirium occurred in 0\/22 (0%) patients in Group R vs. 6\/22 (27.3%) in Group M (risk difference \u221227.3%, 95% CI \u221245.9% to \u22128.7%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.021 by Fisher's exact test). Due to zero events in Group R, Firth's penalized likelihood regression adjusting for Acute Physiology and Chronic Health Evaluation II (APACHE-II) yielded an odds ratio of 0.06 (95% CI 0.00 to 0.56,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.009), and multivariable and propensity score adjustments produced consistent results. E-value analysis (point estimate 2.0, lower CI bound 1.3) indicated that a relatively modest unmeasured confounder could potentially shift the confidence interval to include the null. For secondary outcomes, Group R had shorter recovery time after decannulation (24.90 \u00b1 3.36 h vs. 29.84 \u00b1 4.53 h,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), better-preserved muscle strength (median MRC grade 1 vs. 0,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001), and lower incidences of hypotension and bradycardia (both\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective exploratory study, a remimazolam-based sedation regimen was associated with lower delirium incidence, faster recovery, and better-preserved muscle strength compared with a midazolam-based regimen. These findings reflect a comparison of two distinct sedation regimens rather than a head-to-head drug comparison of remimazolam vs. midazolam. These hypothesis-generating findings warrant further validation in prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1819593","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:36:39Z","timestamp":1780896999000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcomes of a remimazolam-based sedation regimen in patients receiving ECMO: a retrospective comparative study"],"prefix":"10.3389","volume":"13","author":[{"given":"Dalong","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongrui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjie","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijun","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingguo","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou","place":["Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"373","DOI":"10.3949\/ccjm.83a.15021","article-title":"Extracorporeal membrane oxygenation in adults: a practical guide for internists","volume":"83","author":"Kulkarni","year":"2016","journal-title":"Cleve Clin J Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.jtcvs.2016.02.067","article-title":"Contemporary extracorporeal membrane oxygenation therapy in 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