Optimizing pharmacotherapy regimens in adult patients receiving extracorporeal membrane oxygenation: A narrative review for clinical pharmacists

Abstract

Extracorporeal membrane oxygenation (ECMO) is a complex therapy aimed at providing mechanical support for patients with severe, life-threating cardiac and/or respiratory failure. Research has demonstrated variability in pharmacokinetic changes in the critically ill patient population receiving ECMO. There is a need to understand the complexity of these pharmacokinetic changes to provide optimal pharmacotherapeutic regimens thereby maximizing effectiveness and mitigating harm. However, the number of pharmacokinetic studies in patients receiving ECMO remains small, and very few prospective studies have been published addressing optimal analgesic, sedative, or antimicrobial therapy. Anticoagulation is an additional important component of ECMO therapy but the preferred agent as well as dosing and monitoring strategy are unclear. The purpose of this narrative review is to discuss analgesia and sedation, antimicrobial, and anticoagulation management strategies in adult patients receiving ECMO.

Critical care pharmacists have a rich history and evolving roles

“…Similarly, new devices, technologies and novel serologic and imaging biomarkers will require new therapeutic approaches and assessments. 26 Alternate technology platforms such as tele-ICU will continue to grow as illustrated during the coronavirus disease 2019 (COVID-19) pandemic to optimize care of patients through a region, health system, or locally across every shift. 27 Pharmacists should be included to maximize the optimal use of these platforms.…”