Meropenem Exposure During Extracorporeal Membrane Oxygenation: What Should Intensivists Know? A Scoping Review

Area of Science:

• Critical Care Medicine
• Pharmacokinetics
• Infectious Diseases

Background:

• Extracorporeal membrane oxygenation (ECMO) use is rising in severe respiratory/cardiac failure.
• Altered drug pharmacokinetics (PK) complicates antimicrobial dosing in ECMO patients.
• Meropenem disposition during ECMO requires further understanding.

Purpose of the Study:

• To characterize population PK methodologies for meropenem in ECMO patients.
• To synthesize evidence on meropenem PK/PD in critically ill adults on ECMO.
• To identify factors influencing meropenem exposure and target attainment.

Main Methods:

• Scoping review following PRISMA-ScR guidelines.
• Searched Embase, PubMed, LILACS, ProQuest, Web of Science, Scopus (2012-2022).
• Included studies reporting meropenem PK/PD in adult ICU patients on ECMO.

Main Results:

• Eleven studies met inclusion criteria (cohorts, case series, simulations).
• Glomerular filtration rate (GFR) and renal replacement therapy (RRT) were key determinants of meropenem clearance.
• Standard meropenem dosing often failed to reach PK/PD targets, especially with augmented renal clearance (ARC).

Conclusions:

• Meropenem exposure in ECMO patients is primarily influenced by renal function, RRT, and ARC.
• ECMO's direct effect on meropenem PK is less significant than renal parameters.
• Individualized dosing, PK modeling, and therapeutic drug monitoring (TDM) are essential for optimizing meropenem therapy in this population.