ECMO resource

[pharm B]

Anyone have a good resource that explains the change in pharmacotherapy that comes with putting a kid on ECMO?

Enjoying the summer internship, and I'm definitely getting exposed to a lot of different patients. I found a few articles that address the topic, but if anyone could recommend a good general overview, I'd appreciate it.

The clinical pharmacist I'm working with has said so far that (for an infant) it's almost like doubling the volume of distribution, but there's less clearance. Essentially you need higher dosing at less frequent intervals.

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[Glycerin]

Buck ML, "Pharmacokinetic Changes During Extracorporeal Membrane Oxygenation: Implications for Drug Therapy of Neonates," Clin Pharmacokinet, 2003, 42(5):403-17.[PubMed 12739981]

Southgate WM, DiPiro JT, and Robertson AF, "Pharmacokinetics of Gentamicin in Neonates on Extracorporeal Membrane Oxygenation," Antimicrob Agents Chemother, 1989, 33(6):817-9.[PubMed 2764529]

Leuschen MP, Willett LD, Hoie EB, et al, “Plasma Fentanyl Levels in Infants Undergoing Extracorporeal Membrane Oxygenation,” J Thorac Cardiovasc Surg, 1993, 105(5):885-91.[PubMed 8487566]

Mulla H, Lawson G, Woodland ED, et al, "Effects of Neonatal Extracorporeal Membrane Oxygenation Circuits on Drug Disposition," Curr Ther Res Clin Exp, 2000, 61:838-48.

van der Staak FH, de Haan AF, Geven WB, et al, "Surgical Repair of Congenital Diaphragmatic Hernia During Extracorporeal Membrane Oxygenation: Hemorrhagic Complications and the Effect of Tranexamic Acid," J Pediatr Surg, 1997, 32(4):594-9.[PubMed 9126762]

McBride BF, White CM, Campbell M, et al, "Nicardipine to Control Neonatal Hypertension During Extracorporeal Membrane Oxygen Support," Ann Pharmacother, 2003, 37(5):667-70.[PubMed 12708943]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC163279/pdf/401139.pdf - R. DAVIS AMAKER, JOSEPH T. DiPIRO, AND JATINDER BHATIA. Pharmacokinetics of Vancomycin in Critically Ill Infants Undergoing Extracorporeal Membrane Oxygenation. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, May 1996, p. 1139–1142

Those should keep you busy. Also, I'd look through pediatric critical care and infectious diseases textbooks.

Drugs to consider adjusting in pediatric ECMO: vanco, gent, tobra, furosemide, nicardipine, heparin (obviously on level), ranitidine, fentanyl, and midazolam. There are more, but those are the common ones that I see.

Good luck.

 

[ucrx]

McBride BF, White CM, Campbell M, et al, "Nicardipine to Control Neonatal Hypertension During Extracorporeal Membrane Oxygen Support," Ann Pharmacother, 2003, 37(5):667-70.[PubMed 12708943]

I'm pretty sure I read this article a few months ago and I just noticed that one of the authors is one of my favorite professors from pharmacy school. Weird.