Evidence map›Paper›PMID 42257859›Full record

ArticlePediatric surgery international2026

Fentanyl Utilization During Extracorporeal Membrane Oxygenation and Risk of Methadone Treatment Among Pediatric ECMO Survivors.

Rabab M Barq, Shadassa Ourshalimian, Olivia A Keane, Lara P Nelson, Ashwini Lakshmanan, Henry C Lee, Eugene Kim, Susan R Hintz, Asavari Kamerkar, Lorraine I Kelley-Quon

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric surgery international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Rabab M BarqDivision of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #100, Los Angeles, CA, 90027, USA. rabab.barq@vcuhealth.org.
Shadassa OurshalimianDivision of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #100, Los Angeles, CA, 90027, USA.
Olivia A KeaneDivision of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #100, Los Angeles, CA, 90027, USA.
Lara P NelsonDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Ashwini LakshmananDepartment of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA.
Henry C LeeDivision of Neonatology, University of California San Diego, La Jolla, CA, USA.
Eugene KimDivision of Pain Medicine, Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Susan R HintzDepartment of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Palo Alto, CA, USA.
Asavari KamerkarDepartment of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Lorraine I Kelley-QuonDivision of Pediatric Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #100, Los Angeles, CA, 90027, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionSingle center studies suggest utilization of fentanyl during extracorporeal membrane oxygenation (ECMO) may be associated with a higher risk of opioid withdrawal. This study evaluated fentanyl use during ECMO and subsequent methadone or buprenorphine treatment among pediatric ECMO survivors in a large multi-center cohort.

methodsThis retrospective study included children < 18y treated at 41 U.S. children's hospitals in the Pediatric Health Information System between 2013 and 2023. Multivariable hierarchical regression was used to assess the relationship between fentanyl exposure on ECMO and likelihood of receiving methadone or buprenorphine after ECMO, adjusting for covariates including other opioid exposures.

resultsOverall, 4,365 children were included (55.5% male; 47.9% neonatal). Median duration of ECMO was 5 (IQR: 3-8) days. Fentanyl exposure was categorized into quartiles:0-1 days, 2 days, 3-4 days, and ≥ 5 days. On multivariable regression, children in the 3-4 days quartile (OR 1.32; 95% CI: 1.05-1.65) and ≥ 5 days quartile (OR 2.21; 95% CI: 1.71-2.85) were more likely to receive methadone or buprenorphine after ECMO compared to those in the 0-1 days quartile. On bivariate comparison, children who received fentanyl during ECMO were found to have prolonged ventilator dependence, TPN use, and post-ECMO length of stay.

conclusionPatients receiving fentanyl while on ECMO had an increased risk of receiving methadone or buprenorphine treatment post-ECMO, suggesting a higher risk of opioid withdrawal in patients receiving fentanyl while on ECMO. Our findings underscore a need for expanded opioid stewardship initiatives to utilize alternative pain management and minimize fentanyl prescribing for children undergoing ECMO.

Indexed as

Analgesics, OpioidExtracorporeal Membrane OxygenationFentanylMethadoneSubstance Withdrawal SyndromeAdolescentChildChild, PreschoolFemaleHumansInfantInfant, NewbornMaleRetrospective StudiesSurvivorsAnalgesics, OpioidFentanylMethadoneCritical illnessExtracorporeal membrane oxygenation (ECMO)FentanylMethadoneOpioid dependenceOpioid toleranceOpioid withdrawal

Identifiers

PMID42257859
PMCPMC13246929

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.