ASAIO Journal

Pharmacokinetic of commonly used drugs during #ECMO: 🔍 systematic review including 44 articles presenting ex-vivo, animal, & human data, and examining 30 medications 💉 opioid analgesics: morphine, fentanyl, sufentanil, reminfentanil, hydromorphone 💉 analgesics: paracetamol 💉 sedatives: dexmedetomidine, propofol, thiopentone 💉 benzodiazepines: midazolam, lorazepam, diazepam 💉 anticonvulsants: phenobarbital, phenytoin & fosphenytoin, valproic acid, lacosamide & levetiracetam 💉 immunosupressants: tacrolimus, mycophenolate mofetil, cyclosporine 💉 vasoactive drugs: dopamine & epinephrine, clonidine, treprostinil, levosimendan 💉 antiarrhythmics: amiodarone 💉 diuretics: bumetanide 💉 H2 blockers: ranitidine 💉 corticosteroids: hydrocortisone PK varied depending on medication’s characteristics, study type, & population. Study quality variable, limiting the possibility of deriving hard dosing guidelines from available literature. ASAIO Journal 📎 https://bit.ly/3NLO0AC

Association between tidal Volume & mortality in children in #ECMO 🔍 retrospective cohort study aimed to determine relationship between conventional Vt (4–8 ml/kg) vs low tidal volume (<4 ml/kg) & mortality in pediatric patients on mechanical ventilation at ECMO initiation 🫁 Vt < 4 ml/kg at #ECLS initiation, regardless of disease severity & reason for ECMO support, associated with higher odds of mortality, longer postdecannulation ventilation, greater need for bronchoscopies 🫁 lung-protective bundles should consider Vt to maintain plateau & driving pressure levels that may prevent major lung injury ASAIO Journal 🔗 https://bit.ly/4e9IthU

Multiple pediatric #ECMO runs: what are the limits? 🔍 single pediatric center, 2010-23 🔎 13% children required multiple runs; use of multiple runs increased within study period 🪦 mortality 80% before discharge; late 89%: significantly higher vs single runs 🧠 67% neurologic complication; 1% normal neurodevelopment at followup. All patients with neurologic findings before second run died: this should be taken into consideration considering an additional run 🚧 duration of first run, total time on #ECLS, neurologic findings at any time, need for #RRT, lactate correlated with late mortality. Carefully discuss risks & benefits before considering; shorter/fewer runs could provide a more compassionate approach for families facing desperate situations ASAIO Journal 🔗 https://bit.ly/3BUHBjV