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Related Experiment Videos

Sedative clearance during extracorporeal membrane oxygenation.

Varsha Bhatt-Meht1, Gail Annich

  • 1Department of Pharmacy Services, College of Pharmacy, Ann Arbor, MI, USA. varsham@umich.edu

Perfusion
|December 21, 2005
PubMed
Summary

Polyvinyl chloride (PVC) tubing and membrane oxygenators (MO) in extracorporeal membrane oxygenation (ECMO) circuits significantly reduce lorazepam and morphine concentrations. This drug adsorption increases with circuit age, potentially explaining higher sedative doses in patients.

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Area of Science:

  • Pharmacokinetics and Drug Metabolism
  • Biomedical Engineering
  • Neonatal Intensive Care

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a life support system used for neonates with severe cardiorespiratory failure.
  • Sedative medications like lorazepam and morphine are crucial for patient comfort and management during ECMO.
  • The extracorporeal circuit, including polyvinyl chloride (PVC) tubing and membrane oxygenators (MO), may interact with administered drugs.

Purpose of the Study:

  • To evaluate the impact of PVC tubing and MO on lorazepam and morphine concentrations within a neonatal ECMO circuit.
  • To determine if the age of the ECMO circuit influences drug adsorption.
  • To provide insights into potential reasons for increased sedative requirements in ECMO patients.

Main Methods:

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  • An in vitro closed ECMO circuit model was utilized, including a membrane oxygenator, heat exchanger, bladder, and PVC tubing.
  • The circuit was primed with blood, electrolytes, albumin, and heparin, and maintained at physiological conditions.
  • Lorazepam and morphine were studied separately in new and 24-hour-old circuits, with serial samples collected over 6 hours for analysis via gas chromatography.

Main Results:

  • Significant drug extraction by PVC and MO was observed, with up to 50% of lorazepam and 40% of morphine being adsorbed.
  • Drug adsorption increased as the ECMO circuits aged.
  • Concentrations were measured at various time points and sites within the circuit, including pre- and post-MO.

Conclusions:

  • PVC tubing and MO significantly reduce lorazepam and morphine concentrations in ECMO circuits.
  • The extent of drug adsorption is dependent on the age of the circuit, increasing over time.
  • These findings may partially explain the higher doses of sedatives needed for effective patient management during ECMO.