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Review
. 2022 Mar 4;11(3):338.
doi: 10.3390/antibiotics11030338.

Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides

Francisco Gomez  1 , Jesyree Veita  2 , Krzysztof Laudanski  3   4   5
Affiliations
Review

Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides

Francisco Gomez et al. Antibiotics (Basel). .

Abstract

Extracorporeal membrane oxygenation (ECMO) is an emerging treatment modality associated with a high frequency of antibiotic use. However, several covariables emerge during ECMO implementation, potentially jeopardizing the success of antimicrobial therapy. These variables include but are not limited to: the increased volume of distribution, altered clearance, and adsorption into circuit components, in addition to complex interactions of antibiotics in critical care illness. Furthermore, ECMO complicates the assessment of antibiotic effectiveness as fever, or other signs may not be easily detected, the immunogenicity of the circuit affects procalcitonin levels and other inflammatory markers while disrupting the immune system. We provided a review of pharmacokinetics and pharmacodynamics during ECMO, emphasizing practical application and review of patient-, illness-, and ECMO hardware-related factors.

Keywords: ECMO; antibiotics; critical illness; extracorporeal membrane oxygenation; pharmacodynamics; pharmacokinetics.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Sample VV ECMO circuit and possible cannulation sites.
Figure 2
Figure 2
The level of the antibiotics are gradually increasing over the time to cross the MAB, MIB and MBC threshold, but only above MBC thresholds can the antibiotics eradicate infection instead of augmenting the immune system function.
Figure 3
Figure 3
ECMO-specific factor affecting drug distribution.
Figure 4
Figure 4
General recommendations regarding antibiotics as classified by hydrophilicity or lipophilicity [47,81,82,102].
See this image and copyright information in PMC

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References

    1. Combes A., Peek G.J., Hajage D., Hardy P., Abrams D., Schmidt M., Dechartres A., Elbourne D. ECMO for severe ARDS: Systematic review and individual patient data meta-analysis. Intensive Care Med. 2020;46:2048–2057. doi: 10.1007/s00134-020-06248-3. - DOI - PMC - PubMed
    1. Dagan O., Klein J., Gruenwald C., Bohn D., Barker G., Koren G. Preliminary studies of the effects of extracorporeal membrane oxygenator on the disposition of common pediatric drugs. Ther. Drug Monit. 1993;15:263–266. doi: 10.1097/00007691-199308000-00001. - DOI - PubMed
    1. Wildschut E.D., Ahsman M.J., Allegaert K., Mathot R.A., Tibboel D. Determinants of drug absorption in different ECMO circuits. Intensive Care Med. 2010;36:2109–2116. doi: 10.1007/s00134-010-2041-z. - DOI - PMC - PubMed
    1. Zapol W.M., Snider M.T., Hill J.D., Fallat R.J., Bartlett R.H., Edmunds L.H., Morris A.H., Peirce E.C., Thomas A.N., Proctor H.J. Extracorporeal membrane oxygenation in severe acute respiratory failure: A randomized prospective study. JAMA. 1979;242:2193–2196. doi: 10.1001/jama.1979.03300200023016. - DOI - PubMed
    1. Tramm R., Ilic D., Davies A.R., Pellegrino V.A., Romero L., Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst. Rev. 2015;1:Cd010381. doi: 10.1002/14651858.CD010381.pub2. - DOI - PMC - PubMed

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