Medication Complications in Extracorporeal Membrane Oxygenation

Area of Science:

• Pharmacology and Critical Care Medicine
• Drug pharmacokinetics in critical illness

Background:

• Extracorporeal membrane oxygenation (ECMO) is used for severe organ failure.
• ECMO necessitates multiple medications for patient management.
• Physiologic changes during ECMO impact drug pharmacokinetics.

Purpose of the Study:

• To review existing drug dosing data for patients on ECMO.
• To provide practical guidance for medication management in ECMO therapy.
• To address the pharmacokinetic challenges associated with ECMO.

Main Methods:

• Literature review of published drug dosing studies in ECMO patients.
• Analysis of pharmacokinetic alterations specific to ECMO.
• Synthesis of data to inform dosing recommendations.

Main Results:

• Drug pharmacokinetics are significantly altered by ECMO.
• These alterations can lead to sub-therapeutic drug levels or toxicity.
• Pharmacokinetic changes are drug-dependent and not well-characterized for many agents.

Conclusions:

• Optimizing drug dosing during ECMO is critical for patient outcomes.
• Further research is needed to define drug-specific pharmacokinetic changes.
• This review offers initial guidance for clinicians managing medications in ECMO patients.