Medication adsorption into contemporary extracorporeal membrane oxygenator circuits

• Published in: The journal of pediatric pharmacology and therapeutics Vol. 19; no. 4; pp. 288 - 295
• Main Authors: Harthan, Aaron A, Buckley, Klayton W, Heger, Margaret L, Fortuna, Randall S, Mays, Kyle
• Format: Journal Article
• Language: English
• Published: United States Pediatric Pharmacy Advocacy Group 01.10.2014
• Subjects: Clinical Investigations; pharmacokinetics; extracorporeal; polymethylpentane
• ISSN: 1551-6776; 2331-348X
• DOI: 10.5863/1551-6776-19.4.288

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. 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. 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. 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.