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. 2014 Oct-Dec;19(4):288-95.
doi: 10.5863/1551-6776-19.4.288.

Medication adsorption into contemporary extracorporeal membrane oxygenator circuits

Aaron A Harthan  1 , Klayton W Buckley  2 , Margaret L Heger  1 , Randall S Fortuna  3 , Kyle Mays  1
Affiliations

Medication adsorption into contemporary extracorporeal membrane oxygenator circuits

Aaron A Harthan et al. J Pediatr Pharmacol Ther. 2014 Oct-Dec.

Abstract

Objective: This study was conducted to evaluate the amount of medication adsorbed into extracorporeal membrane oxygenation (ECMO) circuits with a polymethylpentane membrane oxygenator and heparin-coated polyvinyl chloride tubing.

Methods: An ECMO circuit with the aforementioned components was set up ex vivo and primed with expired blood. Midazolam, lorazepam, morphine, and fentanyl were administered to the circuit. Fifteen minutes after medication administration, 60 mL of blood were removed and stored in a 60-mL syringe to serve as a control. Medication levels were drawn from the ECMO circuit (test) and control syringe (control) 15 minutes, 24 hours, and 48 hours after the medications were administered. ECMO circuit medication levels were compared to their corresponding syringe control medication levels. Descriptive statistics were used to determine the percentage of medication remaining in the blood and compare it to the control value.

Results: Except for morphine, there was a large decline in medication levels over the 48-hour period. Compared to control values, 17.2% of midazolam, 41.3% of lorazepam, 32.6% of fentanyl, and 102% of morphine remained in the ECMO circuit.

Conclusion: Despite the use of newer components in ECMO circuits, a large quantity of medication is adsorbed into the ECMO circuit. Midazolam, lorazepam, and fentanyl all showed reductions in medication levels greater than 50%. Morphine may have advantages for patients on ECMO, as its concentration does not appear to be affected.

Keywords: extracorporeal; pharmacokinetics; polymethylpentane.

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Figures

Figure 1.
Figure 1.
The percent change of midazolam concentrations when compared to the initial values in control and test samples. formula image Midazolam, control; formula image Midazolam, test
Figure 2.
Figure 2.
The percent change of lorazepam concentrations when compared to the initial values in lorazepam control and test samples. formula image Lorazepam, control; formula image Lorazepam, test
Figure 3.
Figure 3.
The percent change of morphine concentrations when compared to the initial values in morphine control and test samples. Control morphine levels were extrapolated, as the 24-hour control value was not available. formula image Morphine, control; formula image Morphine, test; formula image Expon. (Morphine, control)
Figure 4.
Figure 4.
The percent change of lorazepam concentrations when compared to the initial values in fentanyl control and test samples. Control fentanyl levels were extrapolated, as the 48-hour control value was not available. formula image Lorazepam, control; formula image Lorazepam, test; formula image Expon. (Lorazepam, control)
See this image and copyright information in PMC

References

    1. Buck ML. Pharmacokinetic changes during extracorporeal membrane oxygenation: implications for drug therapy of neonates. Clin Pharmacokinet. 2003;42(5):403–417. - PubMed
    1. Cohen P, Collart L, Prober CG et al. Gentamicin pharmacokinetics in neonates undergoing extracorporeal membrane oxygenation. Pediatr Infect Dis J. 1990;9(8):562–566. - PubMed
    1. Dodge WF, Jelliffe RW, Zwischenberger JB et al. Population pharmacokinetic models: effect of explicit versus assumed constant serum concentration assay error patterns upon parameter values of gentamicin in infants on and off extracorporeal membrane oxygenation. Ther Drug Monit. 1994;16(6):552–559. - PubMed
    1. Amaker RD, DiPiro JT, Bhatia J. Pharmacokinetics of vancomycin in critically ill infants undergoing extracorporeal membrane oxygenation. Antimicrob Agents Chemother. 1996;40(5):1139–1142. - PMC - PubMed
    1. Buck ML. Vancomycin pharmacokinetics in neonates receiving extracorporeal membrane oxygenation. Pharmacotherapy. 1998;18(5):1082–1086. - PubMed

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