Drug Administration Patterns in Patients on Extracorporeal Membrane Oxygenation

This study aimed to identify drug administration patterns in patients of all ages supported with extracorporeal membrane oxygenation (ECMO) across multiple institutions and determine which of the most commonly administered drugs lack published dosing guidance. We conducted a retrospective, multicenter database study using the TriNetX data network and the Pediatric Health Information Systems database. All adults and children supported with ECMO were included for analysis. Drug exposure and days of use were described according to age category (Infants [<2 years], Children [≥2 and <18 years], and Adults [≥18 years]). The literature was reviewed for the top 50 most commonly administered drugs in all ages; all pharmacokinetic and ex vivo studies were included. A total of 17,909 patients were analyzed. The patient population comprised 24% adults (n = 4,253), 18% children (n = 3266), and 58% infants (n = 10,390). The 10 most commonly administered drugs, by days of use, were heparin, furosemide, midazolam, morphine, fentanyl, vancomycin, milrinone, hydrocortisone, epinephrine, and lorazepam. Published literature comprised 86 studies, including 66 pharmacokinetic studies (77%) and 20 ex vivo studies (23%). Of these, 29% (n = 19) were conducted in adults, 14% (n = 9) were conducted in children, and 60% (n = 39) were performed in infants. ECMO-specific dosing guidance for any age was available for only 28% (n = 14) of the top 50 most commonly administered drugs. Sedatives, antimicrobials, and cardiovascular agents are among the most commonly administered drugs in patients supported with ECMO. This study highlights an urgent need for evidence-based dosing guidance in this patient population.