Medication adsorption into contemporary extracorporeal membrane oxygenator circuits

Area of Science:

• Pharmacology
• Biomedical Engineering
• Critical Care Medicine

Background:

• Extracorporeal membrane oxygenation (ECMO) circuits utilize specialized tubing and oxygenators.
• Understanding drug behavior within these circuits is crucial for effective patient management.

Purpose of the Study:

• To quantify the adsorption of common medications into ECMO circuits.
• To evaluate the impact of specific ECMO components on drug concentrations.

Main Methods:

• An ex vivo ECMO circuit with a polymethylpentane membrane oxygenator and heparin-coated tubing was used.
• Midazolam, lorazepam, fentanyl, and morphine were administered, with drug levels measured over 48 hours.
• Drug concentrations in the ECMO circuit were compared to control blood samples.

Main Results:

• Significant adsorption was observed for midazolam (82.8%), lorazepam (58.7%), and fentanyl (67.4%).
• Morphine showed minimal adsorption, with 102% of the initial level remaining in the circuit.
• These findings indicate substantial drug loss into ECMO components.

Conclusions:

• Current ECMO circuits lead to significant adsorption of commonly used sedatives and analgesics.
• Morphine appears to be a more stable option for analgesia in ECMO patients due to minimal adsorption.
• Further research is needed to optimize drug delivery and dosing strategies in ECMO.