Related Experiment Video

Updated: Jun 4, 2026

Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
04:55

Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest

Published on: May 26, 2023

Pediatric cardiovascular drug dosing in critically ill children and extracorporeal membrane oxygenation

Kevin Watt1, Jennifer S Li, Daniel K Benjamin

  • 1Department of Pediatrics Duke University, Durham, NC, USA.

Journal of Cardiovascular Pharmacology
|February 25, 2011
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) significantly alters drug pharmacokinetics in critically ill children. More research is crucial to establish safe and effective cardiovascular drug dosing for pediatric ECMO patients.

Area of Science:

  • Pediatric critical care medicine
  • Cardiovascular pharmacology
  • Extracorporeal life support

Background:

  • Cardiovascular disease is a significant cause of morbidity and mortality in children.
  • Extracorporeal membrane oxygenation (ECMO) is a vital therapy for pediatric cardiorespiratory failure.
  • Limited pharmacokinetic data exist for cardiovascular drugs in pediatric ECMO patients.

Purpose of the Study:

  • To review the current understanding of cardiovascular drug pharmacokinetics in pediatric ECMO patients.
  • To identify drugs that may require dosing adjustments during ECMO support.
  • To highlight the need for further research in this area.

Main Methods:

  • Literature review of studies reporting pharmacokinetic data for cardiovascular drugs in pediatric ECMO patients.
  • Analysis of existing case reports and limited trials.
  • Categorization of drugs based on potential need for dosing modification.

Main Results:

  • Pharmacokinetic alterations (clearance, volume of distribution) are suggested by the ECMO circuit.
  • Eleven cardiovascular drugs have been partially studied in pediatric ECMO patients.
  • Some drugs (esmolol, amiodarone, nesiritide, bumetanide, sildenafil, prostaglandin E1) may require dosing changes, while others (hydralazine, nicardipine, furosemide, epinephrine, dopamine) might not.
  • Definitive dosing recommendations are not possible due to limited trial data.

Conclusions:

  • Significant knowledge gaps exist regarding cardiovascular drug pharmacokinetics in pediatric ECMO.
  • Current data are primarily based on limited case reports, precluding definitive dosing guidelines.
  • Further research evaluating drug pharmacokinetics in ECMO patients is essential to optimize therapy and prevent adverse events.

Related Concept Videos

Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Cardiopulmonary Resuscitation IV: Pharmacological Management01:25

Cardiopulmonary Resuscitation IV: Pharmacological Management

Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...