• Corpus ID: 58067341

Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO)

@inproceedings{Wildschut2010DrugTI,
  title={Drug therapies in neonates and children during extracorporeal membrane oxygenation (ECMO)},
  author={Enno Diederik Wildschut},
  year={2010}
}
__Abstract__ Extracorporeal life support (ECLS) or extra corporeal membrane oxygenation (ECMO) is a technique for providing life support in severe but potentially reversible cardiorespiratory failure in patients with an expected mortality greater than 80%. First pioneered in cardiopulmonary bypass during cardiac surgery, ECLS has been used as prolonged cardiopulmonary support in neonates since 1976. It has been shown to have a survival benefit in neonates and adults. Increasingly ECMO… 
Pediatric Cardiovascular Drug Dosing in Critically Ill Children and Extracorporeal Membrane Oxygenation
TLDR
Research efforts should focus on evaluating the PK of drugs in patients on ECMO to avoid therapeutic failures or unnecessary toxicities, and definitive dosing recommendations are not plausible.
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TLDR
This review will explore the available literature, identify possible changes in pharmacokinetics and make suggestions for future research directions on therapeutic hypothermia in the neonatal ECMO population.
Innovative clinical trial design for pediatric therapeutics
TLDR
Until approximately 15 years ago, sponsors rarely included children in the development of therapeutics, but national research networks in Europe and the USA are beginning to address some of the gaps in pediatric therapeutics using novel clinical trial designs.

References

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Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy.
TLDR
Extracorporeal membrane oxygenation (ECMO) is used in the treatment of 13 moribund infants (including 9 neonates), with 4 survivors (3 neonates).
Pharmacokinetic Changes During Extracorporeal Membrane Oxygenation
  • M. Buck
  • Medicine
    Clinical pharmacokinetics
  • 2003
TLDR
The literature published to date on the pharmacokinetic changes associated with ECMO provide preliminary support for dosage adjustment; however, more research is needed to identify optimal administration strategies for this patient population.
Neonatal extracorporeal membrane oxygenation complicated by sepsis. Extracorporeal Life Support Organization.
TLDR
A critical reappraisal of continued aggressive support may be warranted when septic complications develop in neonates during ECMO, and new strategies to prevent sepsis and associated thrombotic and metabolic complications may be indicated.
Enhanced hemolysis in pediatric patients requiring extracorporeal membrane oxygenation and continuous renal replacement therapy.
TLDR
It is suggested that there is enhanced hemolysis during combined ECMO and CRRT compared with ECMO alone, and the clinical impact of increasedhemolysis on renal function in patients receiving ECMO with or without CRRT remains to be determined.
Effects of neonatal extracorporeal membrane oxygenation circuits on drug disposition
TLDR
There is significant interaction between the PVC and silicone components of an ECMO circuit and the sedative drugs that pass through them, which may affect the bioavailability of these drugs and hence the doses required to induce a therapeutic effect.
The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation.
TLDR
This study shows that the introduction of a CRRT device into the ECMO circuit is a safe and effective technique that improves fluid balance, increases filter life, and does not cause complications.
Gentamicin pharmacokinetics in neonates undergoing extracorporal membrane oxygenation
TLDR
It is concluded that gentamicin and probably other aminoglycosides should be given at dose rates about 25% lower than usual and at longer dosing intervals in patients undergoing ECMO therapy.
Pharmacokinetics of vancomycin in critically ill infants undergoing extracorporeal membrane oxygenation
TLDR
In comparison with previously published data, the neonates undergoing ECMO in this study demonstrated a much larger volume of distribution, a lower clearance, and consequently a longer vancomycin half-life, suggesting alterations in the pharmacokinetics of vancomYcin in infants on ECMO.
Gentamicin Pharmacokinetics in Term Neonates Receiving Extracorporeal Membrane Oxygenation
TLDR
The objective of this study was to determine if the pharmacokinetics of gentamicin in neonates on ECMO are affected by oxygenator surface area, and to compare them to reported values for a similar patient population not onECMO.
Predictors of outcome in patients with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation.
TLDR
No pre-ECMO variable could be identified as predictor of mortality and prolonged duration of ECMO and renal complications on ECMO were independently associated with mortality.
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