Medication and Dose Optimization in Extracorporeal Membrane Oxygenation
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Review
VOLUME: 22 ISSUE: 1
P: 1 - 14
March 2024

Medication and Dose Optimization in Extracorporeal Membrane Oxygenation

J Turk Soc Intens Care 2024;22(1):1-14
1. Hacettepe Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık Anabilim Dalı, Ankara, Türkiye
2. Hacettepe Üniversitesi Eczacılık Fakültesi, Ankara, Türkiye
No information available.
No information available
Received Date: 28.11.2023
Accepted Date: 08.02.2024
Publish Date: 07.03.2024
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ABSTRACT

Extracorporeal membrane oxygenation (ECMO) increases circulating volume of distribution, leading to capillary leakage and temporarily altering renal function. Therefore, this may affect pharmacokinetics. In this review, factors affecting pharmacokinetics and pharmacodynamics in veno-arterial and venovenous ECMO, the causes of drug sequestration that may occur in the ECMO circuit, the effects of physicochemical parameters of drugs in the ECMO circuit, and ECMO variable dose optimization have been reviewed from the studies in the current literature. Data reported on the limitations, indications and complications of ECMO are also mentioned. The limited use of ECMO in the coronavirus disease-2019 pandemic, its use in reported cases, and which symptoms it is usually used to support the treatment of are described.

Keywords:
Extracorporeal membrane oxygenation, ECMO circuit, drug, pharmacokinetics, pharmacodynamics, dose adjustment

References

1
Mosier JM, Kelsey M, Raz Y, Gunnerson KJ, Meyer R, Hypes CD, et al. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: history, current applications, and future directions. Crit Care 2015;19:431.
2
Makdisi G, Wang IW. Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 2015;7:166-76.
3
Szentgyorgyi L, Shepherd C, Dunn KW, Fawcett P, Barker JM, Exton P, et al. Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury. Burns 2018;44:1091-9.
4
Ha MA, Sieg AC. Evaluation of Altered Drug Pharmacokinetics in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation. Pharmacotherapy 2017;37:221-35.
5
Sherwin J, Heath T, Watt K. Pharmacokinetics and Dosing of Anti-infective Drugs in Patients on Extracorporeal Membrane Oxygenation: A Review of the Current Literature. Clin Ther 2016;38:1976-94.
6
Hahn J, Choi JH, Chang MJ. Pharmacokinetic changes of antibiotic, antiviral, antituberculosis and antifungal agents during extracorporeal membrane oxygenation in critically ill adult patients. J Clin Pharm Ther 2017;42:661-71.
7
Himebauch AS, Kilbaugh TJ, Zuppa AF. Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review. Expert Opin Drug Metab Toxicol 2016;12:1133-42.
8
Abdul-Aziz MH, Shekar K, Roberts JA. Antimicrobial therapy during ECMO - customised dosing with therapeutic drug monitoring: The way to go? Anaesth Crit Care Pain Med 2019;38:451-3.
9
Sargel CL, Thompson RZ, Brax A. Vancomycin Pharmacokinetics During Extracorporeal Membrane Oxygenation and Dosing Targets-A Constantly Moving Target? Pediatr Crit Care Med 2018;19:1002-3.
10
Moffett BS, Morris J, Galati M, Munoz F, Arikan AA. Population Pharmacokinetics of Vancomycin in Pediatric Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 2018;19:973-80.
11
Lemaitre F, Hasni N, Leprince P, Corvol E, Belhabib G, Fillatre P, et al. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit Care 2015;19:40.
12
Abdul-Aziz MH, Roberts JA. Antibiotic dosing during extracorporeal membrane oxygenation: does the system matter? Curr Opin Anaesthesiol 2020;33:71-82.
13
Touchard C, Aubry A, Eloy P, Brechot N, Lebreton G, Franchineau G, et al. Predictors of insufficient peak amikacin concentration in critically ill patients on extracorporeal membrane oxygenation. Crit Care 2018;22:199.
14
Ruiz-Ramos J, Gimeno R, Perez F, Ramirez P, Villarreal E, Gordon M, et al. Pharmacokinetics of Amikacin in Critical Care Patients on Extracorporeal Device. ASAIO J 2018;64:686-8.
15
Gelisse E, Neuville M, de Montmollin E, Bouadma L, Mourvillier B, Timsit JF, et al. Extracorporeal membrane oxygenation (ECMO) does not impact on amikacin pharmacokinetics: a case-control study. Intensive Care Med 2016;42:946-8.
16
Moffett BS, Morris J, Galati M, Munoz FM, Arikan AA. Population Pharmacokinetic Analysis of Gentamicin in Pediatric Extracorporeal Membrane Oxygenation. Ther Drug Monit 2018;40:581-8.
17
Shekar K, Fraser JF, Taccone FS, Welch S, Wallis SC, Mullany DV, et al. The combined effects of extracorporeal membrane oxygenation and renal replacement therapy on meropenem pharmacokinetics: a matched cohort study. Crit Care 2014;18:565.
18
Hanberg P, Obrink-Hansen K, Thorsted A, Bue M, Tottrup M, Friberg LE, et al. Population Pharmacokinetics of Meropenem in Plasma and Subcutis from Patients on Extracorporeal Membrane Oxygenation Treatment. Antimicrob Agents Chemother 2018;62:e02390-17.
19
Andresen M, Araos J, Wong KY, Leung YC, So LY, Wong WT, et al. Evaluation of Meropenem Pharmacokinetics in an Experimental Acute Respiratory Distress Syndrome (ARDS) Model during Extracorporeal Membrane Oxygenation (ECMO) by Using a PenP beta-Lactamase Biosensor. Sensors 2018;18:1424.
20
Jaruratanasirikul S, Vattanavanit V, Wongpoowarak W, Nawakitrangsan M, Samaeng M. Pharmacokinetics and Monte Carlo Dosing Simulations of Imipenem in Critically Ill Patients with Life-Threatening Severe Infections During Support with Extracorporeal Membrane Oxygenation. Eur J Drug Metab Pharmacokinet 2020;45:735-47.
21
Donadello K, Antonucci E, Cristallini S, Roberts JA, Beumier M, Scolletta S, et al. beta-Lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: A case-control study. Int J Antimicrob Agents 2015;45:278-82.
22
Bougle A, Dujardin O, Lepere V, Ait Hamou N, Vidal C, Lebreton G, et al. PHARMECMO: Therapeutic drug monitoring and adequacy of current dosing regimens of antibiotics in patients on Extracorporeal Life Support. Anaesth Crit Care Pain Med 2019;38:493-7.
23
Shekar K, Roberts JA, McDonald CI, Ghassabian S, Anstey C, Wallis SC, et al. Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study. Crit Care 2015;19:164.
24
Turner RB, Rouse S, Elbarbry F, Wanek S, Grover V, Chang E. Azithromycin Pharmacokinetics in Adults With Acute Respiratory Distress Syndrome Undergoing Treatment With Extracorporeal-Membrane Oxygenation. Ann Pharmacother 2016;50:72-3.
25
Cies JJ, Moore WS, Giliam N, Low T, Enache A, Chopra A. Impact of ex-vivo extracorporeal membrane oxygenation circuitry on daptomycin. Perfusion 2018;33:624-9.
26
Strunk AK, Ciesek S, Schmidt JJ, Kuhn C, Hoeper MM, Welte T, et al. Single- and multiple-dose pharmacokinetics of ethambutol and rifampicin in a tuberculosis patient with acute respiratory distress syndrome undergoing extended daily dialysis and ECMO treatment. Int J Infect Dis 2016;42:1-3.
27
Van Daele R, Bruggemann RJ, Dreesen E, Depuydt P, Rijnders B, Cotton F, et al. Pharmacokinetics and target attainment of intravenous posaconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother 2021;76:1234-41.
28
Watt KM, Gonzalez D, Benjamin DK Jr, Brouwer KL, Wade KC, Capparelli E, et al. Fluconazole population pharmacokinetics and dosing for prevention and treatment of invasive Candidiasis in children supported with extracorporeal membrane oxygenation. Antimicrob Agents Chemother 2015;59:3935-43.
29
Watt KM, Cohen-Wolkowiez M, Barrett JS, Sevestre M, Zhao P, Brouwer KLR, et al. Physiologically Based Pharmacokinetic Approach to Determine Dosing on Extracorporeal Life Support: Fluconazole in Children on ECMO. CPT Pharmacometrics Syst Pharmacol 2018;7:629-37.
30
Zhao Y, Seelhammer TG, Barreto EF, Wilson JW. Altered Pharmacokinetics and Dosing of Liposomal Amphotericin B and Isavuconazole during Extracorporeal Membrane Oxygenation. Pharmacotherapy 2020;40:89-95.
31
Brown MA, Najam F, Pocock ES, Munoz PF, Farrar KA, Yamane DP. A comparison of bivalirudin and heparin for patients on extracorporeal membrane oxygenation. Thromb Res 2020;190:76-8.
32
Kaseer H, Soto-Arenall M, Sanghavi D, Moss J, Ratzlaff R, Pham S, et al. Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation. J Card Surg 2020;35:779-86.
33
Nei SD, Wittwer ED, Kashani KB, Frazee EN. Levetiracetam Pharmacokinetics in a Patient Receiving Continuous Venovenous Hemofiltration and Venoarterial Extracorporeal Membrane Oxygenation. Pharmacotherapy 2015;35:127-30.
34
Pokorna P, Sima M, Vobruba V, Tibboel D, Slanar O. Phenobarbital pharmacokinetics in neonates and infants during extracorporeal membrane oxygenation. Perfusion 2018;33:80-6.
35
Tukacs M. Pharmacokinetics and Extracorporeal Membrane Oxygenation in Adults: A Literature Review. AACN Adv Crit Care 2018;29:246-58.
36
Shah AG, Peahota M, Thoma BN, Kraft WK. Medication Complications in Extracorporeal Membrane Oxygenation. Crit Care Clin 2017;33:897-920.
37
Di Nardo M, Wildschut ED. Drugs pharmacokinetics during veno-venous extracorporeal membrane oxygenation in pediatrics. J Thorac Dis 2018;10:642-52.
38
Cheng V, Abdul-Aziz MH, Roberts JA, Shekar K. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J Thorac Dis 2018;10:629-41.
39
Cheng V, Abdul-Aziz MH, Roberts JA, Shekar K. Overcoming barriers to optimal drug dosing during ECMO in critically ill adult patients. Expert Opin Drug Metab Toxicol 2019;15:103-12.
40
Dzierba AL, Abrams D, Brodie D. Medicating patients during extracorporeal membrane oxygenation: the evidence is building. Crit Care 2017;21:66.
41
Brodie D, Curtis JR, Vincent JL, Bakker J, Brown CE, Creteur J, et al. Treatment limitations in the era of ECMO. Lancet Respir Med 2017;5:769-70.
42
Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care 2016;20:387.