The DOI matches its Crossref record; 46 of the 47 references it cites were found in a registry or an index.
Pharmacokinetic Changes During Extracorporeal Membrane Oxygenation: Implications for Drug Therapy of Neonates
Abstract
Extracorporeal membrane oxygenation (ECMO) is a prolonged form of cardiopulmonary bypass used to support patients with life-threatening respiratory or cardiac failure. In neonates, ECMO is used for a variety of indications, including sepsis and pulmonary diseases such as meconium aspiration syndrome, persistent pulmonary hypertension or congenital diaphragmatic hernia. In recent years, ECMO has been increasingly used after surgery to correct congenital cardiac defects. Despite the need for numerous drugs to maintain the ECMO circuit and treat the patient's underlying illness, relatively little is known of the disposition of drugs in this patient population. To date, the largest number of pharmacokinetic studies have been conducted with gentamicin and vancomycin. Both drugs have been found to have an increased volume of distribution, probably as a result of the addition of a large exogenous blood volume for circuit priming. Elimination half-lives for both drugs are prolonged during ECMO, with several studies demonstrating a return to expected values after decannulation. The reason for this prolonged elimination is probably multifactorial, with a reduction in renal function as the primary determinant. This same pattern of an increased volume of distribution and prolonged elimination has been found for several other drugs, including tobramycin, bumetanide and ranitidine. Other factors that affect drug disposition during ECMO include loss of the drug from adhesion to the circuit components and loss in the circulating blood volume during changes in the equipment. The benzodiazepines and propofol are largely sequestered within the circuit. Serum concentrations of heparin, morphine, fentanyl, furosemide, phenytoin and phenobarbital are also reduced by these mechanisms. The addition of haemofiltration or dialysis in up to a quarter of ECMO patients further complicates the determination of population pharmacokinetic parameters. 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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“Although dosing regimens have been well established in this population, there are limited data regarding changes in dosing imposed by the use of ECLS devices.”
From Phenobarbital use in an infant requiring extracorporeal membrane life support (2013) · cites this paper as [7]
Citations
Cites
Arnold, J. H., Truog, R. D., Orav, E. J., Scavone, J. M., & Hershenson, M. B. (1990) · Anesthesiology · doi:10.1097/00000542-199012000-00011 · Cited by 228
Jaggers, J. J., Forbess, J. M., Shah, A. S., Meliones, J. N., Kirshbom, P. M., Miller, C. E., & Ungerleider, R. M. (2000) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(00)01330-8 · Cited by 167
Franck, L. S., Vilardi, J., Durand, D. J., & Powers, R. (1998) · American Journal of Critical Care · doi:10.4037/ajcc1998.7.5.364 · Cited by 149
Changes in the pharmacodynamic response to fentanyl in neonates during continuous infusion
ARNOLD, J., Truog, R. D., Scavone, J. M., & Fenton, T. R. (1991) · The Journal of Pediatrics · doi:10.1016/s0022-3476(05)82419-9 · Cited by 148
Coagulation and Anticoagulation in Extracorporeal Membrane Oxygenation
Muntean, W. E. (1999) · Artificial Organs · doi:10.1046/j.1525-1594.1999.06451.x · Cited by 120
Roy, B. J., Rycus, P. T., Conrad, S. A., & Clark, R. H. (2000) · PEDIATRICS · doi:10.1542/peds.106.6.1334 · Cited by 118
Dagan, O., Klein, J., Gruenwald, C., Bohn, D., Barker, G., & Koren, G. (1993) · Therapeutic Drug Monitoring · doi:10.1097/00007691-199308000-00001 · Cited by 107
In vitro evaluation of sedative drug losses during extracorporeal membrane oxygenation
Mulla, H., Lawson, G., von Anrep, C., Burke, M. D., Upton, D. U., Firmin, R. K., & Killer, H. (2000) · Perfusion · doi:10.1177/026765910001500104 · Cited by 103
Amaker, R. D., DiPiro, J. T., & Bhatia, J. J. S. (1996) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.40.5.1139 · Cited by 89
Gentamicin pharmacokinetics in neonates undergoing extracorporal membrane oxygenation
COHEN, P., COLLART, L., PROBER, C. G., FISCHER, A. F., & BLASCHKE, T. F. (1990) · The Pediatric Infectious Disease Journal · doi:10.1097/00006454-199008000-00007 · Cited by 80
Research works printed but not linked: 6
- Buck, 1995, Pharmacotherapy, 15, 384
- Munzenberger, 1991, ASAIO Trans, 37, 16, 10.1097/00002480-199101000-00006 · DOI
- Hoie, 1990, Clin Pharm, 9, 711
- Roy, 1995, Pediatrics, 95, 573
- Hoie, 1993, Am J Hosp Pharm, 50, 1902
- Marx, 1991, Pharmacotherapy, 11, 270
Cited by
Pharmacokinetic changes in patients receiving extracorporeal membrane oxygenation
Shekar, K., Fraser, J. F., Smith, M. T., & Roberts, J. A. (2012) · Journal of Critical Care · doi:10.1016/j.jcrc.2012.02.013 · Cited by 355
Shekar, K., Roberts, J. A., McDonald, C. I., Fisquet, S., Barnett, A. G., Mullany, D. V., Ghassabian, S., Wallis, S. C., Fung, Y. L., Smith, M. T., et al. (2012) · Critical Care · doi:10.1186/cc11679 · Cited by 306
Determinants of drug absorption in different ECMO circuits
Wildschut, E. D., Ahsman, M. J., Allegaert, K., Mathot, R. A. A., & Tibboel, D. (2010) · Intensive Care Medicine · doi:10.1007/s00134-010-2041-z · Cited by 254
Shekar, K., Roberts, J. A., McDonald, C. I., Ghassabian, S., Anstey, C., Wallis, S. C., Mullany, D. V., Fung, Y. L., & Fraser, J. F. (2015) · Critical Care · doi:10.1186/s13054-015-0891-z · Cited by 250
Mehta, N. M., Halwick, D. R., Dodson, B. L., Thompson, J. E., & Arnold, J. H. (2007) · Intensive Care Medicine · doi:10.1007/s00134-007-0606-2 · Cited by 191
Metadata
- Authors
- Buck, M. L.
- Affiliations
- University of Virginia Health System (US)
- Corresponding author
- Buck, Marcia L
- ORCID
- Buck, Marcia L
- Venue
- Clinical Pharmacokinetics
- Published
- 2003
- Volume
- 42
- Issue
- 5
- Pages
- 403-417
- ISSN
- 0312-5963 (ISSN-L)
- OpenAlex
- W145838624
- Cited by
- 179
- References
- 47
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 4 · 2022: 4 · 2021: 9 · 2020: 9 · 2019: 8 · 2018: 10 · 2017: 19 · 2016: 14 · 2015: 3 · 2014: 9 · 2013: 7 · 2012: 18
- FWCI
- 0.54
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Pharmacokinetics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Health Sciences › Medicine › Pharmacology (medical) › Antibiotics Pharmacokinetics and Efficacy
- Keywords
- extracorporeal membrane oxygenation, pharmacokinetics, drug disposition, neonates, gentamicin, vancomycin, volume of distribution, elimination half-life, renal function, hemofiltration, dialysis, dose adjustment, congenital heart disease, sepsis, meconium aspiration syndrome, persistent pulmonary hypertension, congenital diaphragmatic hernia
- MeSH terms
- Animals, Pharmaceutical Preparations, Humans, Infant, Newborn, Pharmacokinetics, Extracorporeal Membrane Oxygenation, Models, Animal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
