Skip to main content
SpringerLink
Log in

Drug Clearance on ECMO and Dialysis/CRRT

  • Chapter
  • First Online:
Handbook of Pediatric Cardiovascular Drugs

  • 1844 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vrancken SL, Heijst AF, Zegers M, et al. Influence of volume replacement with colloids versus crystalloids in neonates on venoarterial extracorporeal membrane oxygenation on fluid retention, fluid balance, and ECMO runtime. ASAIO J. 2005;51:808–12.

    Article  CAS  PubMed  Google Scholar 

  2. Kazzi NJ, Schwartz CA, Palder SB, et al. Effect of extracorporeal membrane oxygenation on body water content and distribution in lambs. ASAIO Trans. 1990;36:817–20.

    Article  CAS  PubMed  Google Scholar 

  3. Rosen DA, Rosen KR, Leong P. Uptake of lorazepam and midazolam by the Scimed membrane oxygenator. Anesthesiology. 1990;73:A474.

    Article  Google Scholar 

  4. Dagan O, Klein J, Greunwald C, et al. Preliminary studies of the effects of extracorporeal membrane oxygenator on the disposition of common pediatric drugs. Ther Drug Monit. 1993;15:233–6.

    Article  Google Scholar 

  5. Mulla H, Lawson G, von Anrep C, et al. In vitro evaluation of sedative drug losses during extracorporeal membrane oxygenation. Perfusion. 2000;15:21–6.

    Article  CAS  PubMed  Google Scholar 

  6. Hoie EB, Hall MC, Schaff LJ. Effects of injection site and flow rate on the distribution of injected solutions in an extracorporeal membrane oxygenation circuit. Am J Hosp Pharm. 1993;50:1902–6.

    CAS  PubMed  Google Scholar 

  7. Shevde K, DuBois WJ. Pro: pulsatile flow is preferable to nonpulsatile flow during cardiopulmonary bypass. J Cardiothorac Anesth. 1987;1:165–8.

    Article  CAS  PubMed  Google Scholar 

  8. Mavroudis C. To pulse or not to pulse. Ann Thorac Surg. 1978;25:259–71.

    Article  CAS  PubMed  Google Scholar 

  9. Hynynen M, Olkkola KT, Naveri E, et al. Thiopentone pharmacokinetics during cardiopulmonary bypass with a nonpulsatile or pulsatile flow. Acta Anaesthesiol Scand. 1989;33:554–60.

    Article  CAS  PubMed  Google Scholar 

  10. Bartlett RH. Extracorporeal life support for cardiopulmonary failure. Curr Probl Surg. 1990;27:621–705.

    Article  CAS  PubMed  Google Scholar 

  11. Bentley JB, Conahan III TJ, Cork RC. Fentanyl sequestration in the lungs during cardiopulmonary bypass. Clin Pharmacol Ther. 1983;34:703–6.

    Article  CAS  PubMed  Google Scholar 

  12. Churchwell MD, Mueller BA. Drug dosing during continuous renal replacement therapy. Semin Dial. 2009;22:185–8.

    Article  PubMed  Google Scholar 

  13. Pea F, Viale P, Pavan F, Furlanut M. Pharmacokinetic considerations for antimicrobial therapy in patients receiving renal replacement therapy. Clin Pharmacokinet. 2007;46:997–1038.

    Article  CAS  PubMed  Google Scholar 

  14. Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser Jr CD. Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol. 1999;13:641–5.

    Article  CAS  PubMed  Google Scholar 

  15. Stromberg D, Fraser Jr CD, Sorof JM, Drescher K, Feltes TF. Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management. Tex Heart Inst J. 1997;24:269–77.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Picca S, Ricci Z, Picardo S. Acute kidney injury in an infant after cardiopulmonary bypass. Semin Nephrol. 2008;28:470–6.

    Article  PubMed  Google Scholar 

  17. Ponce D, Brito GA, Abrao JG, Balb AL. Different prescribed doses of high-volume peritoneal dialysis and outcome of patients with acute kidney injury. Adv Perit Dial. 2011;27:118–24.

    CAS  PubMed  Google Scholar 

  18. Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol. 2000;15:11–3.

    Article  CAS  PubMed  Google Scholar 

  19. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.

    Article  CAS  PubMed  Google Scholar 

  20. Symons JM, Chua AN, Somers MJ, Baum MA, Bunchman TE, Benfield MR, Brophy PD, Blowey D, Fortenberry JD, Chand D, Flores FX, Hackbarth R, Alexander SR, Mahan J, McBryde KD, Goldstein SL. Demographic characteristics of pediatric continuous renal replacement therapy: a report of the prospective pediatric continuous renal replacement therapy registry. Clin J Am Soc Nephrol. 2007;2:732–8.

    Article  PubMed  Google Scholar 

  21. Honore PM, Matson JR. Hemofiltration, adsorption, sieving and the challenge of sepsis therapy design. Crit Care. 2002;6:394–6.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Veltri MA, Neu AM, Fivush BA, Parekh RS, Furth SL. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy: special considerations in pediatric patients. Paediatr Drugs. 2004;6:45–65.

    Article  PubMed  Google Scholar 

  23. Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359:7–20.

    Article  CAS  PubMed  Google Scholar 

  24. Bellomo R, McGrath B, Boyce N. Effect of continuous venovenous hemofiltration with dialysis on hormone and catecholamine clearance in critically ill patients with acute renal failure. Crit Care Med. 1994;22:833–7.

    Article  CAS  PubMed  Google Scholar 

  25. Baird JS. The sieving coefficient and clearance of vasopressin during continuous renal replacement therapy in critically ill children. J Crit Care. 2010;25:591–4.

    Article  CAS  PubMed  Google Scholar 

  26. Pfaender M, Casetti PG, Azzolini M, Baldi ML, Valli A. Successful treatment of a massive atenolol and nifedipine overdose with CVVHDF. Minerva Anestesiol. 2008;74:97–100.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein MD

  2. Department of Pediatrics, Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    David S. Cooper MD, MPH

Authors
  1. Stuart L. Goldstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David S. Cooper MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David S. Cooper MD, MPH .

Editor information

Editors and Affiliations

  1. Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Ricardo Munoz

  2. Children’s Hospital Colorado, Aurora, Colorado, USA

    Eduardo M. da Cruz

  3. Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Carol G. Vetterly

  4. Cincinnati Children’s Hospital, Cincinnati, USA

    David S. Cooper

  5. Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Donald Berry

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Goldstein, S.L., Cooper, D.S. (2014). Drug Clearance on ECMO and Dialysis/CRRT. In: Munoz, R., da Cruz, E., Vetterly, C., Cooper, D., Berry, D. (eds) Handbook of Pediatric Cardiovascular Drugs. Springer, London. https://doi.org/10.1007/978-1-4471-2464-1_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2464-1_17

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2463-4

  • Online ISBN: 978-1-4471-2464-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation