Pharmacotherapy during pediatric extracorporeal membrane oxygenation: a review.
BACKGROUND
Pediatric critical illness and associated alterations in organ function can change drug pharmacokinetics (PK). Extracorporeal membrane oxygenation (ECMO), a life-saving therapy for severe cardiac and/or respiratory failure, causes additional PK alterations that affect drug disposition.


METHODS
The purposes of this review are to discuss the PK changes that occur during ECMO, the associated therapeutic implications, and to review PK literature relevant to pediatric ECMO. We discuss various classes of drugs commonly used for pediatric patients on ECMO, including sedatives, analgesics, antimicrobials and cardiovascular drugs. Finally, we discuss future areas of research and recommend strategies for future pediatric ECMO pharmacologic investigations.


CONCLUSIONS
Clinicians caring for pediatric patients treated with ECMO must have an understanding of PK alterations that could lead to either therapeutic failures or increased drug toxicity during this life-saving therapy. Limited data currently exist for optimal drug dosing in pediatric populations who are treated with ECMO. While there are clear challenges to conducting and analyzing data associated with clinical pharmacokinetic-pharmacodynamic studies of children on ECMO, we present techniques to address these challenges. Improved understanding of the physiology and drug disposition during ECMO combined with PK-PD modeling will allow for more adaptable and individualized dosing schemes.
a Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine , University of Pennsylvania, The Children's Hospital of Philadelphia , Philadelphia , PA , USA.|b Center for Clinical Pharmacology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Adam S
AS
Himebauch
a Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine , University of Pennsylvania, The Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Todd J
TJ
Kilbaugh
a Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine , University of Pennsylvania, The Children's Hospital of Philadelphia , Philadelphia , PA , USA.|b Center for Clinical Pharmacology , The Children's Hospital of Philadelphia , Philadelphia , PA , USA.
Athena F
AF
Zuppa
D000818:Animals; D002648:Child; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D008954:Models, Biological; D004364:Pharmaceutical Preparations / Q000008:administration & dosage* / Q000378:metabolism; D010599:Pharmacokinetics; D057285:Precision Medicine
D004364:Pharmaceutical Preparations
ECMO; pediatric; pharmacodynamics; pharmacokinetics