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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Determinants of drug absorption in different ECMO circuits
E D Wildschut1, M J Ahsman, K Allegaert
1Intensive Care and Department of Paediatric Surgery, Sophia Children's Hospital, Erasmus MC, Dr Molewaterplein 60, 3000 CB, Rotterdam, The Netherlands. e.wildschut@erasmusmc.nl
Intensive Care Medicine
|September 24, 2010
Summary
Drug absorption in extracorporeal membrane oxygenation (ECMO) circuits significantly impacts drug levels. Centrifugal pump circuits with hollow-fibre membranes show less drug loss, especially for lipophilic medications, altering pharmacokinetics.
Area of Science:
- Pharmacology
- Biomedical Engineering
- Critical Care Medicine
Background:
- Drug administration and efficacy in patients requiring extracorporeal membrane oxygenation (ECMO) can be complex.
- Understanding drug behavior within ECMO circuits is crucial for optimizing patient treatment.
Purpose of the Study:
- To investigate potential factors influencing drug loss within various extracorporeal membrane oxygenation (ECMO) circuits.
- To quantify drug recovery rates in different ECMO circuit configurations.
Main Methods:
- An in vitro study involving the injection of seven common drugs (midazolam, morphine, fentanyl, paracetamol, cefazolin, meropenem, vancomycin) into neonatal and pediatric roller pump circuits and centrifugal pump circuits.
- Serial blood sampling post-oxygenator to determine drug recovery rates.
- Correlation analysis between drug lipophilicity (log P) and absorption.
Main Results:
- Significant drug absorption was observed in ECMO circuits, with recovery rates varying widely by drug and circuit type.
- Drug recovery correlated significantly with drug lipophilicity (p < 0.001).
- Centrifugal pump circuits with hollow-fibre membranes demonstrated significantly higher drug recovery (e.g., midazolam 63.4%, fentanyl 33.8%) compared to silicone membrane roller pump circuits (e.g., midazolam 0.62%, fentanyl 0.35%).
Conclusions:
- Extracorporeal membrane oxygenation (ECMO) circuits significantly absorb drugs, particularly lipophilic ones.
- Centrifugal pump circuits with hollow-fibre membranes exhibit reduced drug absorption compared to roller pump circuits.
- Altered drug pharmacokinetics during ECMO necessitate potential dose adjustments.
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