Drug clearance on ECMO and dialysis/CRRT

Abstract

Use of extracorporeal membrane oxygenation (ECMO) in the pediatric, and particularly neonatal, population to support patients with cardiopulmonary failure has become increasingly commonplace over the past two decades. However, there has been a relative paucity of research into the effects of ECMO on drug metabolism and elimination in children. Extracorporeal clearance of medications imparts a significant clinical challenge to the medical team caring for critically ill children, particularly with acute kidney injury (AKI). Rational drug dosing in this situation requires knowledge of multiple properties of the specific medication, modality of renal supportive therapy (RST), dialysis membrane characteristics and the dialysis dose. However, minimal in vitro or in vivo measured pharmacokinetic data exist for cardiovascular drugs in the setting of pediatric RST. Given these tenants, frequent monitoring of drug levels and therapeutic effects are recommended to ensure proper dosing in the child receiving ECMO support.