Harthan Aaron A, Buckley Klayton W, Heger Margaret L, Fortuna Randall S, Mays Kyle
Pharmacy Department, Children's Hospital of Illinois, Peoria, Illinois.
Perfusion Department, Children's Hospital of Illinois, Peoria, Illinois.
J Pediatr Pharmacol Ther. 2014 Oct-Dec;19(4):288-95. 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.
本研究旨在评估使用聚甲基戊烷膜式氧合器和肝素涂层聚氯乙烯管路的体外膜肺氧合（ECMO）回路中吸附的药物量。
在体外建立一个具有上述组件的ECMO回路，并用过期血液预充。向回路中注入咪达唑仑、劳拉西泮、吗啡和芬太尼。给药15分钟后，抽取60 mL血液并储存在一个60 mL注射器中作为对照。在给药后15分钟、24小时和48小时，从ECMO回路（测试组）和对照注射器（对照组）中抽取药物水平样本。将ECMO回路中的药物水平与其相应的注射器对照药物水平进行比较。使用描述性统计来确定血液中剩余药物的百分比，并将其与对照值进行比较。
除吗啡外，在48小时内药物水平大幅下降。与对照值相比，咪达唑仑在ECMO回路中剩余17.2%，劳拉西泮剩余41.3%，芬太尼剩余32.6%，吗啡剩余102%。
尽管在ECMO回路中使用了更新的组件，但仍有大量药物被吸附到ECMO回路中。咪达唑仑、劳拉西泮和芬太尼的药物水平均下降超过50%。吗啡可能对接受ECMO治疗的患者具有优势，因为其浓度似乎未受影响。
