DRUG DOSING AND PHARMACOLOGICAL EFFECTS IN ECMO: A COMPREHENSIVE REVIEW
DOI:
https://doi.org/10.22159/ijpps.2026v18i5.58333Keywords:
Extracorporeal membrane oxygenation (ECMO), Pharmacokinetics, Therapeutic drug monitoring (TDM), Drug sequestration, AntimicrobialsAbstract
Extracorporeal membrane oxygenation (ECMO) serves as a critical life-support modality for patients with severe cardiac or respiratory failure, yet the large surface area of the circuit introduces significant variability in the pharmacokinetics (PK) and pharmacodynamics (PD) of essential medications. This systematic review evaluates clinical evidence from 2015 to 2025 regarding drug dosing alterations in adult ECMO patients, focusing on anticoagulants, antibacterials, antifungals, and antivirals. Our analysis identifies drug sequestration as a primary determinant of therapeutic failure, particularly for highly lipophilic agents like voriconazole and fentanyl, which exhibit circuit losses exceeding 70% within hours of administration. Conversely, hydrophilic antibiotics such as beta-lactams and glycopeptides are primarily impacted by an increased volume of distribution (Vd) and augmented renal clearance, often necessitating loading dose increases of 20–50% or the use of extended infusions to maintain therapeutic levels. Regarding anticoagulation, evidence supports the superiority of anti-Xa (target 0.3–0.7 IU/ml) and viscoelastic assays over activated clotting time (ACT) for minimizing hemorrhagic risks. Current dosing guidelines remain fragmented; thus, clinicians must adopt individualized strategies involving aggressive therapeutic drug monitoring (TDM) and multimodal anticoagulation assessment to ensure efficacy and safety in this high-risk population.
Downloads
References
1. Hill JD, O’Brien TG, Murray JJ, Dontigny L, Bramson ML, Osborn JJ. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome) use of the Bramson membrane lung. N Engl J Med. 1972;286(12):629-34. doi: 10.1056/NEJM197203232861204, PMID 5060491.
2. Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (Cesar): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-63. doi: 10.1016/S0140-6736(09)61069-2, PMID 19762075.
3. Shekar K, Fraser JF, Smith MT, Roberts JA. Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation. J Crit Care. 2012;27(6):741.e9-18. doi: 10.1016/j.jcrc.2012.02.013, PMID 22520488.
4. Tonna JE, Boonstra PS, MacLaren G, Paden M, Brodie D, Anders M. Extracorporeal life support organization registry international report 2022: 100,000 survivors. ASAIO J. 2024;70(2):131-43. doi: 10.1097/MAT.0000000000002128, PMID 38181413.
5. Rali AS, Abbasi A, Alexander PM, Anders MM, Arachchillage DJ, Barbaro RP. Adult highlights from the extracorporeal life support organization registry: 2017-2022. ASAIO J. 2024;70(1):1-7. doi: 10.1097/MAT.0000000000002038, PMID 37755405.
6. Low CJ, Ramanathan K, Ling RR, Ho MJ, Chen Y, Lorusso R. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis. Lancet Respir Med. 2023;11(10):883-93. doi: 10.1016/S2213-2600(23)00137-6, PMID 37230097.
7. Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the extracorporeal life support organization registry. Lancet. 2020;396(10257):1071-8. doi: 10.1016/S0140-6736(20)32008-0, PMID 32987008.
8. Abdul-Aziz MH, Roberts JA. Antimicrobial pharmacokinetic considerations in extracorporeal membrane oxygenation. Antibiotics (Basel). 2023;12(8):1234.
9. Ha MA, Sieg AC. Evaluation of altered drug pharmacokinetics in critically ill adults receiving extracorporeal membrane oxygenation. Pharmacotherapy. 2017;37(2):221-35. doi: 10.1002/phar.1882, PMID 27931091.
10. Stead C. The global extracorporeal life support organization chapter: South West Asia and Africa extracorporeal life support organization in 2024. JCCC. 2024;8:66-9. doi: 10.25259/JCCC_12_2024.
11. Cheng V, Abdul Aziz MH, Roberts JA, Shekar K. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J Thorac Dis. 2018;10(Suppl 5):S629-41. doi: 10.21037/jtd.2017.09.154, PMID 29732181.
12. Shekar K, Roberts JA, Mcdonald CI, Fisquet S, Barnett AG, Mullany DV. Sequestration of drugs in the circuit may lead to therapeutic failure during extracorporeal membrane oxygenation. Crit Care. 2012;16(5):R194. doi: 10.1186/cc11679, PMID 23068416.
13. Hou J, Wang C, Wei R, Zheng J, Liu Z, Wang D. Risk factors associated with hospital mortality in non-surgical patients receiving extracorporeal membrane oxygenation and continuous renal replacement treatment: a retrospective analysis. Ren Fail. 2024;46(2):2398711. doi: 10.1080/0886022X.2024.2398711, PMID 39238266.
14. Sun K, Yao C, Xu G, Wang J, Shou S, Jin H. Research progress on the pathogenesis of AKI complicated by ECMO. Clin Exp Nephrol. 2025;29(1):10-20. doi: 10.1007/s10157-024-02559-7, PMID 39340702.
15. Mulla H, Peek GJ, Harvey C, Westrope C, Kiff K, Felton T. Oseltamivir pharmacokinetics in critically ill adults receiving extracorporeal membrane oxygenation. J Antimicrob Chemother. 2013;68(4):889-93.
16. Gor AP, Gajjar B, Dalwadi Z, Goyal A. Analysis of adverse drug events reported at peripheral ADR monitoring centre in Gujarat. Int J Pharm Pharm Sci. 2020;12(6):72-5.
17. Akbulut AC, Arisz RA, Baaten CC, Baidildinova G, Barakzie A, Bauersachs R. Blood coagulation and beyond: position paper from the fourth Maastricht consensus conference on thrombosis. Thromb Haemost. 2023;123(8):808-39. doi: 10.1055/a-2052-9175, PMID 36913975.
18. Helms J, Frere C, Thiele T, Tanaka KA, Neal MD, Steiner ME. Anticoagulation in adult patients supported with extracorporeal membrane oxygenation: guidance from the scientific and standardization committees on perioperative and critical care hemostasis and thrombosis of the International Society on thrombosis and haemostasis. J Thromb Haemost. 2023;21(2):373-96. doi: 10.1016/j.jtha.2022.11.014, PMID 36700496.
19. Durila M, Vajter J, Garaj M, Berousek J, Lischke R, Hlavacek M. Intravenous enoxaparin guided by anti-Xa in venovenous extracorporeal membrane oxygenation: a retrospective single-center study. Artif Organs. 2024;49(3):486-96. doi: 10.1111/aor.14879, PMID 39360891.
20. Bursa F, Maca J, Sagan J, Sklienka P, Nemcova S, Kucerova Z. A safety comparison of heparin and argatroban anticoagulation in veno-venous extracorporeal membrane oxygenation with a focus on bleeding. Transfus Med. 2024;35(1):75-81. doi: 10.1111/tme.13102, PMID 39375884.
21. Vajter J, Holubova G, Novysedlak R, Svorcova M, Vachtenheim J, Vymazal T. Anaesthesiologic considerations for intraoperative ECMO anticoagulation during lung transplantation: a single-center retrospective observational study. Transpl Int. 2024;37:12752. doi: 10.3389/ti.2024.12752, PMID 38585623.
22. Rajsic S, Breitkopf R, Treml B, Jadzic D, Innerhofer N, Eckhardt C. Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: a systematic review and meta-analysis. Clin Cardiol. 2024;47(5):e24273. doi: 10.1002/clc.24273, PMID 38693831.
23. Terry K, Lonardo N, Tonna J. Anticoagulation levels and bleeding after emergency department extracorporeal cardiopulmonary resuscitation. Curr Emerg Hosp Med Rep. 2019;7(1):1-5. doi: 10.1007/s40138-019-00176-3.
24. Panigada M, Cucino A, Spinelli E, Occhipinti G, Panarello G, Novembrino C. A randomized controlled trial of antithrombin supplementation during extracorporeal membrane oxygenation. Crit Care Med. 2020;48(11):1636-44. doi: 10.1097/CCM.0000000000004590, PMID 32947474.
25. Panigada M, E Iapichino G, Brioni M, Panarello G, Protti A, Grasselli G. Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation: a safety and feasibility pilot study. Ann Intensive Care. 2018;8(1):7. doi: 10.1186/s13613-017-0352-8, PMID 29340875.
26. Kaseer H, Soto Arenall M, Sanghavi D, Moss J, Ratzlaff R, Pham S. Heparin vs bivalirudin anticoagulation for extracorporeal membrane oxygenation. J Card Surg. 2020;35(4):779-86. doi: 10.1111/jocs.14458, PMID 32048330.
27. Oude Lansink Hartgring A, De Vries AJ, Droogh JM, Van Den Bergh WM. Hemorrhagic complications during extracorporeal membrane oxygenation the role of anticoagulation and platelets. J Crit Care. 2019;54:239-43. doi: 10.1016/j.jcrc.2019.09.013, PMID 31630073.
28. Rodrigues AB, Rodrigues A, Correia CJ, Jesus GN, Ribeiro JM. Anticoagulation management in V-V ECMO patients: a multidisciplinary pragmatic protocol. J Clin Med. 2024;13(3):719. doi: 10.3390/jcm13030719, PMID 38337414.
29. Wagle L, Thomas AA, Shrestha S. Drug utilisation study of stroke and other patients admitted to general ward of neurology unit at quaternary care private hospital. Int J Curr Pharm Res. 2017;9(4):23-8. doi: 10.22159/ijcpr.2017v9i4.20630.
30. Kumari J, Shenoy MS, Chakrapani M, Vidyalakshmi K, Bhat KG. In vitro activity of vancomycin and daptomycin against healthcare-associated methicillin-resistant Staphylococcus aureus isolated from clinical specimens. Asian J Pharm Clin Res. 2016;9(3):44-6.
31. Nagler B, Staudinger T, Schellongowski P, Knoebl P, Brock R, Kornfehl A. Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis. J Thromb Haemost. 2024;22(10):2773-83. doi: 10.1016/j.jtha.2024.06.008, PMID 38925491.
32. Aguilar G, Ferriols R, Carbonell JA, Ezquer C, Alonso JM, Villena A. Pharmacokinetics of anidulafungin during venovenous extracorporeal membrane oxygenation. Crit Care. 2016;20(1):325. doi: 10.1186/s13054-016-1501-4, PMID 27745549.
33. Cabanilla MG, Villalobos N. A successful daptomycin and Micafungin dosing strategy in veno-venous ECMO and continuous renal replacement. J Clin Pharm Ther. 2022;47(2):251-3. doi: 10.1111/jcpt.13482, PMID 34254345.
34. Spriet I, Annaert P, Meersseman P, Hermans G, Meersseman W, Verbesselt R. Pharmacokinetics of caspofungin and voriconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother. 2009;63(4):767-70. doi: 10.1093/jac/dkp026, PMID 19218271.
35. Wang Q, Zhang Z, Liu D, Chen W, Cui G, Li P. Population pharmacokinetics of caspofungin among extracorporeal membrane oxygenation patients during the postoperative period of lung transplantation. Antimicrob Agents Chemother. 2020;64(11):e00687-20. doi: 10.1128/AAC.00687-20, PMID 32816724.
36. Ruiz S, Papy E, Da Silva D, Nataf P, Massias L, Wolff M. Potential voriconazole and caspofungin sequestration during extracorporeal membrane oxygenation. Intensive Care Med. 2009;35(1):183-4. doi: 10.1007/s00134-008-1269-3, PMID 18795256.
37. Lyster H, Pitt T, Maunz O, Diamond S, Roberts JA, Brown D. Variable sequestration of antifungals in an extracorporeal membrane oxygenation circuit. ASAIO J. 2023;69(3):309-14. doi: 10.1097/MAT.0000000000001802, PMID 36731055.
38. Watt KM, Cohen Wolkowiez M, Williams DC, Bonadonna DK, Cheifetz IM, Thakker D. Antifungal extraction by the extracorporeal membrane oxygenation circuit. J Extra Corpor Technol. 2017;49(3):150-9. doi: 10.1051/ject/201749150, PMID 28979038.
39. Ye Q, Yu X, Chen W, Li M, Gu S, Huang L. Impact of extracorporeal membrane oxygenation on voriconazole plasma concentrations: a retrospective study. Front Pharmacol. 2022;13:972585. doi: 10.3389/fphar.2022.972585, PMID 36059951.
40. Ronda M, Llop Talaveron JM, Fuset M, Leiva E, Shaw E, Gumucio Sanguino VD. Voriconazole pharmacokinetics in critically ill patients and extracorporeal membrane oxygenation support: a retrospective comparative case-control study. Antibiotics (Basel). 2023;12(7):1100. doi: 10.3390/antibiotics12071100, PMID 37508196.
41. Mathieu A, Thiboutot Z, Ferreira V, Benoit P, Grandjean Lapierre SG, HEtu PO. Voriconazole sequestration during extracorporeal membrane oxygenation for invasive lung aspergillosis: a case report. ASAIO J. 2022;68(3):e56-8. doi: 10.1097/MAT.0000000000001427, PMID 33788798.
42. Peterson EL, Chittick PJ, Richardson CL. Decreasing voriconazole requirement in a patient after extracorporeal membrane oxygenation discontinuation: a case report. Transpl Infect Dis. 2021;23(3):e13545. doi: 10.1111/tid.13545, PMID 33316840.
43. Vu T, Feih J, Juul J. Fluctuating voriconazole concentrations during extracorporeal membrane oxygenation. J Pharm Pract. 2023;36(4):998-1001. doi: 10.1177/08971900211060959, PMID 35612553.
44. Winiszewski H, Rougny AC, Lagoutte Renosi J, Millon L, Capellier G, Navellou JC. The pharmacokinetic challenge of treating invasive aspergillosis complicating severe influenzae assisted by extracorporeal membrane oxygenation. Crit Care. 2018;22(1):355. doi: 10.1186/s13054-018-2285-5, PMID 30577863.
45. Van Daele R, Bekkers B, Lindfors M, Broman LM, Schauwvlieghe A, Rijnders B. A large retrospective assessment of voriconazole exposure in patients treated with extracorporeal membrane oxygenation. Microorganisms. 2021;9(7):1543. doi: 10.3390/microorganisms9071543, PMID 34361978.
46. Van Daele R, Bruggemann RJ, Dreesen E, Depuydt P, Rijnders B, Cotton F. Pharmacokinetics and target attainment of intravenous posaconazole in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother. 2021;76(5):1234-41. doi: 10.1093/jac/dkab012, PMID 33517360.
47. Kriegl L, Hatzl S, Zurl C, Reisinger AC, Schilcher G, Eller P. Isavuconazole plasma concentrations in critically ill patients during extracorporeal membrane oxygenation. J Antimicrob Chemother. 2022;77(9):2500-5. doi: 10.1093/jac/dkac196, PMID 35726095.
48. Mertens B, Wauters J, Debaveye Y, Van Regenmortel N, Degezelle K, Meersseman P. The impact of extracorporeal membrane oxygenation on the exposure to isavuconazole: a plea for thorough pharmacokinetic evaluation. Crit Care. 2022;26(1):227. doi: 10.1186/s13054-022-04093-y, PMID 35897020.
49. 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(1):89-95. doi: 10.1002/phar.2348, PMID 31742741.
50. Branick K, Taylor MJ, Trump MW, Wall GC. Apparent interference with extracorporeal membrane oxygenation by liposomal amphotericin B in a patient with disseminated blastomycosis receiving continuous renal replacement therapy. Am J Health Syst Pharm. 2019;76(11):810-3. doi: 10.1093/ajhp/zxz054, PMID 30994894.
51. Roberts JA, Abdul Aziz MH, Lipman J, Mouton JW, Vinks AA, Felton TW. Individualised antibiotic dosing for patients who are critically ill: challenges and potential solutions. Lancet Infect Dis. 2014;14(6):498-509. doi: 10.1016/S1473-3099(14)70036-2, PMID 24768475.
52. Leven C, Fillatre P, Petitcollin A, Verdier MC, Laurent J, Nesseler N. Ex vivo model to decipher the impact of extracorporeal membrane oxygenation on beta-lactam degradation kinetics. Ther Drug Monit. 2017;39(2):180-4. doi: 10.1097/FTD.0000000000000369, PMID 28033162.
53. Donadello K, Antonucci E, Cristallini S, Roberts JA, Beumier M, Scolletta S. β-lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: a case-control study. Int J Antimicrob Agents. 2015;45(3):278-82. doi: 10.1016/j.ijantimicag.2014.11.005, PMID 25542059.
54. Shekar K, Abdul Aziz MH, Cheng V, Burrows F, Buscher H, Cho YJ. Antimicrobial exposures in critically ill patients receiving extracorporeal membrane oxygenation. Am J Respir Crit Care Med. 2023;207(6):704-20. doi: 10.1164/rccm.202207-1393OC, PMID 36215036.
55. Dhanani JA, Lipman J, Pincus J, Townsend S, Livermore A, Wallis SC. Pharmacokinetics of total and unbound cefazolin during veno-arterial extracorporeal membrane oxygenation: a case report. Chemotherapy. 2019;64(3):115-8. doi: 10.1159/000502474, PMID 31610538.
56. Polain A, Gorham J, Romeo I, Belliato M, Peluso L, Partipilo F. Prediction of insufficient beta-lactam concentrations in extracorporeal membranous oxygenation patients. Microorganisms. 2021;9(11):2219. doi: 10.3390/microorganisms9112219, PMID 34835344.
57. Curtiaud A, Petit M, Chommeloux J, Pineton De Chambrun M, Hekimian G, Schmidt M. Ceftazidime/avibactam serum concentration in patients on ECMO. J Antimicrob Chemother. 2024;79(5):1182-6. doi: 10.1093/jac/dkae091, PMID 38546808.
58. Cies JJ, Moore WS, Giliam N, Low T, Enache A, Chopra A. Oxygenator impact on ceftaroline in extracorporeal membrane oxygenation circuits. Pediatr Crit Care Med. 2018;19(11):1077-82. doi: 10.1097/PCC.0000000000001693, PMID 30048366.
59. Shah A, Sampathkumar P, Stevens RW, Bohman JK, Lahr BD, Dhungana P. Reducing broad-spectrum antimicrobial use in extracorporeal membrane oxygenation: reduce AMMO study. Clin Infect Dis. 2021;73(4):e988-96. doi: 10.1093/cid/ciab118, PMID 33575744.
60. Mehta NM, Halwick DR, Dodson BL, Thompson JE, Arnold JH. Potential drug sequestration during extracorporeal membrane oxygenation: results from an ex vivo experiment. Intensive Care Med. 2007;33(6):1018-24. doi: 10.1007/s00134-007-0606-2, PMID 17404709.
61. Zhang LC, Li QY, Zhang YQ, Shan TC, Li Y, Li YH. Population pharmacokinetics of daptomycin in critically ill patients receiving extracorporeal membrane oxygenation. J Antimicrob Chemother. 2024;79(7):1697-705. doi: 10.1093/jac/dkae171, PMID 38814793.
62. Mehta T, Vindenes T, Beaulac K, Roberts R. Pharmacokinetics of doxycycline in extracorporeal membrane oxygenation. Open Forum Infect Dis. 2015;2(Suppl 1):804. doi: 10.1093/ofid/ofv133.521.
63. Fratoni AJ, Kois AK, Gluck JA, Nicolau DP, Kuti JL. Imipenem/relebactam pharmacokinetics in critically ill patients supported on extracorporeal membrane oxygenation. J Antimicrob Chemother. 2024;79(5):1118-25. doi: 10.1093/jac/dkae079, PMID 38517465.
64. Kuhn D, Metz C, Seiler F, Wehrfritz H, Roth S, Alqudrah M. Antibiotic therapeutic drug monitoring in intensive care patients treated with different modalities of extracorporeal membrane oxygenation (ECMO) and renal replacement therapy: a prospective observational single-center study. Crit Care. 2020;24(1):664. doi: 10.1186/s13054-020-03397-1, PMID 33239110.
65. Honeycutt CC, McDaniel CG, McKnite A, Hunt JP, Whelan A, Green DJ. Meropenem extraction by ex vivo extracorporeal life support circuits. J Extra Corpor Technol. 2023;55(4):159-66. doi: 10.1051/ject/2023035, PMID 38099629.
66. Cheng V, Abdul Aziz MH, Burrows F, Buscher H, Cho YJ, Corley A. Population pharmacokinetics of Piperacillin and Tazobactam in critically ill patients receiving extracorporeal membrane oxygenation: an ASAP ECMO study. Antimicrob Agents Chemother. 2021;65(11):e0143821. doi: 10.1128/AAC.01438-21, PMID 34460303.
67. Fillatre P, Lemaitre F, Nesseler N, Schmidt M, Besset S, Launey Y. Impact of extracorporeal membrane oxygenation (ECMO) support on piperacillin exposure in septic patients: a case-control study. J Antimicrob Chemother. 2021;76(5):1242-9. doi: 10.1093/jac/dkab031, PMID 33569597.
68. Hahn J, Min KL, Kang S, Yang S, Park MS, Wi J. Population pharmacokinetics and dosing optimization of piperacillin-tazobactam in critically ill patients on extracorporeal membrane oxygenation and the influence of concomitant renal replacement therapy. Microbiol Spectr. 2021;9(3):e0063321. doi: 10.1128/Spectrum.00633-21, PMID 34937189.
69. Kim YK, Kim HS, Park S, Kim HI, Lee SH, Lee DH. Population pharmacokinetics of piperacillin/tazobactam in critically ill Korean patients and the effects of extracorporeal membrane oxygenation. J Antimicrob Chemother. 2022;77(5):1353-64. doi: 10.1093/jac/dkac059, PMID 35224630.
70. Veinstein A, Debouverie O, Gregoire N, Goudet V, Adier C, Robert R. Lack of effect of extracorporeal membrane oxygenation on tigecycline pharmacokinetics. J Antimicrob Chemother. 2012;67(4):1047-8. doi: 10.1093/jac/dkr550, PMID 22207598.
71. Cheng V, Abdul Aziz MH, Burrows F, Buscher H, Cho YJ, Corley A. Population pharmacokinetics of vancomycin in critically ill adult patients receiving extracorporeal membrane oxygenation (an ASAP ECMO Study). Antimicrob Agents Chemother. 2022;66(1):e0137721. doi: 10.1128/AAC.01377-21, PMID 34633852.
72. Donadello K, Roberts JA, Cristallini S, Beumier M, Shekar K, Jacobs F. Vancomycin population pharmacokinetics during extracorporeal membrane oxygenation therapy: a matched cohort study. Crit Care. 2014;18(6):632. doi: 10.1186/s13054-014-0632-8, PMID 25416535.
73. Ferre A, Giglio A, Zylbersztajn B, Valenzuela R, Van Sint Jan N, Fajardo C. Analysis of vancomycin dosage and plasma levels in critically ill adult patients requiring extracorporeal membrane oxygenation (ECMO). J Intensive Care Med. 2024;39(9):909-15. doi: 10.1177/08850666241243306, PMID 38557265.
74. Jung Y, Lee DH, Kim HS. Prospective cohort study of population pharmacokinetics and pharmacodynamic target attainment of vancomycin in adults on extracorporeal membrane oxygenation. Antimicrob Agents Chemother. 2021;65(2):e02408-20. doi: 10.1128/AAC.02408-20, PMID 33257444.
75. Moore JN, Healy JR, Thoma BN, Peahota MM, Ahamadi M, Schmidt L. A population pharmacokinetic model for vancomycin in adult patients receiving extracorporeal membrane oxygenation therapy. CPT Pharmacometrics Syst Pharmacol. 2016;5(9):495-502. doi: 10.1002/psp4.12112, PMID 27639260.
76. Buck ML. Pharmacokinetic changes during extracorporeal membrane oxygenation: implications for drug therapy of neonates. Clin Pharmacokinet. 2003;42(5):403-17. doi: 10.2165/00003088-200342050-00001, PMID 12739981.
77. Shekar K, Roberts JA, McDonald CI, Ghassabian S, Anstey C, Wallis SC. Protein-bound drugs are prone to sequestration in the extracorporeal membrane oxygenation circuit: results from an ex vivo study. Crit Care. 2015;19(1):164. doi: 10.1186/s13054-015-0891-z, PMID 25888449.
78. Varghese JM, Roberts JA, Lipman J. Pharmacokinetics and pharmacodynamics in critically ill patients. Curr Opin Anaesthesiol. 2010;23(4):472-8. doi: 10.1097/ACO.0b013e328339ef0a, PMID 20489605.
79. Morales Castro D, Dresser L, Granton J, Fan E. Pharmacokinetic alterations associated with critical illness. Clin Pharmacokinet. 2023;62(2):209-20. doi: 10.1007/s40262-023-01213-x, PMID 36732476.
80. Dzierba AL, Abrams D, Brodie D. Medicating patients during extracorporeal membrane oxygenation: the evidence is building. Crit Care. 2017;21(1):66. doi: 10.1186/s13054-017-1644-y, PMID 28320466.
81. 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(1):387. doi: 10.1186/s13054-016-1570-4, PMID 27890016.
82. Zhang Y, Hu H, Zhang Q, Ou Q, Zhou H, Sha T. Effects of ex vivo extracorporeal membrane oxygenation circuits on sequestration of antimicrobial agents. Front Med (Lausanne). 2021;8:748769. doi: 10.3389/fmed.2021.748769, PMID 34926498.
83. Cies JJ, Moore WS, Giliam N, Low T, Enache A, Chopra A. Oxygenator impact on ceftolozane and tazobactam in extracorporeal membrane oxygenation circuits. Pediatr Crit Care Med. 2020;21(3):276-82. doi: 10.1097/PCC.0000000000002174, PMID 31688715.
84. Shekar K, Roberts JA, Barnett AG, Diab S, Wallis SC, Fung YL. Can physicochemical properties of antimicrobials be used to predict their pharmacokinetics during extracorporeal membrane oxygenation? Illustrative data from ovine models. Crit Care. 2015;19:437. doi: 10.1186/s13054-015-1151-y, PMID 26667471.
Published
How to Cite
Issue
Section
Copyright (c) 2026 TUSHAR JHA, DHANRAJ SHINDE
This work is licensed under a Creative Commons Attribution 4.0 International License.