{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T17:31:59Z","timestamp":1787592719941,"version":"build-2736575974"},"reference-count":59,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,2,3]],"date-time":"2017-02-03T00:00:00Z","timestamp":1486080000000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:p>Extracorporeal membrane oxygenation (<jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content>) is a life\u2010support modality used in patients with refractory cardiac and\/or respiratory failure. A significant resurgence in the use <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> has been seen in recent years as a result of substantial improvements in technology and survival benefit. With expanding <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> use, a better understanding of how <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> affects drug pharmacokinetics (<jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content>) is necessary. The vast majority of <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> studies in patients receiving <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> have been conducted within neonatal or pediatric populations or within a controlled environment (e.g., in vitro or ex vivo). Because of significant differences in absorption, distribution, metabolism, and excretion, it may be inappropriate to extrapolate these <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> data to adults. Thus, the aims of this review are to evaluate the changes in drug <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> during <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> and to summarize the available PK data for common drugs used in the adult critically ill patients during <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> support. A search of the PubMed (1965\u2013July 2016), <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> (1965\u2013July 2016), and Cochrane Controlled Trial Register databases was performed. All relevant studies describing <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> alterations during <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> in ex vivo experiments and in adults were included. Evaluation of the data indicated that drug <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> in adults receiving <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> support may be significantly altered. Factors influencing these alterations are numerous and have intricate relationships with each other but can generally be classified as <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> circuit factors, drug factors, and patient factors. Commonly used drugs in these patients include antimicrobials, sedatives, and analgesics. <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> data for most of these drugs are generally lacking; however, recent research efforts in this patient population have provided some limited guidance in drug dosing. With an improved understanding of altered drug <jats:styled-content style=\"fixed-case\">PK<\/jats:styled-content> secondary to <jats:styled-content style=\"fixed-case\">ECMO<\/jats:styled-content> therapy, optimization of pharmacotherapy within this critically ill population continues to move forward.<\/jats:p>","DOI":"10.1002\/phar.1882","type":"journal-article","created":{"date-parts":[[2016,12,8]],"date-time":"2016-12-08T17:22:38Z","timestamp":1481217758000},"page":"221-235","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":131,"title":["Evaluation of Altered Drug Pharmacokinetics in Critically Ill Adults Receiving Extracorporeal Membrane Oxygenation"],"prefix":"10.1002","volume":"37","author":[{"given":"Michael A.","family":"Ha","sequence":"first","affiliation":[{"name":"Surgical Intensive Care Unit UMass Memorial Medical Center Worcester Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam C.","family":"Sieg","sequence":"additional","affiliation":[{"name":"Heart Transplant\/MCS Gill Heart Institute University of Kentucky Lexington Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,2,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61069-2"},{"key":"e_1_2_11_3_1","unstructured":"Extracorporeal Life Support Registry Report. Available fromhttps:\/\/www.elso.org\/Registry\/Statistics\/InternationalSummary.aspx. Accessed August 15 2016."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/026765910001500104"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-004-2545-5"},{"key":"e_1_2_11_6_1","unstructured":"ELSO guidelines for cardiopulmonary extracorporeal life support extracorporeal life support organization Version 1.3 November 2013. Available fromwww.elso.org\/Resources\/Guidelines.aspx. Accessed June 1 2016."},{"issue":"7","key":"e_1_2_11_7_1","first-page":"E166","article-title":"Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology","volume":"7","author":"Makdisi G","year":"2015","journal-title":"J Thorac Dis"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0b013e31827127e4"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2012.02.013"},{"issue":"3","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1051\/ject\/201042199","article-title":"Modified surface coatings and their effect on drug adsorption within the extracorporeal life support circuit","volume":"42","author":"Preston TJ","year":"2010","journal-title":"J Extra Corpor Technol"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1151"},{"issue":"10","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1097\/INF.0b013e31825d3091","article-title":"Pharmacokinetics and safety of fluconazole in young infants supported with extracorporeal membrane oxygenation","volume":"31","author":"Watt KM","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0267659112456894"},{"issue":"4","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1051\/ject\/200739234","article-title":"In vitro drug adsorption and plasma free hemoglobin levels associated with hollow fiber oxygenators in the extracorporeal life support (ECLS) circuit","volume":"39","author":"Preston TJ","year":"2007","journal-title":"J Extra Corpor Technol"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc11679"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-010-2041-z"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0891-z"},{"issue":"3","key":"e_1_2_11_18_1","first-page":"109","article-title":"Drug disposition during extracorporeal membrane oxygenation (ECMO)","volume":"4","author":"Mulla HGL","year":"2001","journal-title":"Paediatr Perinat Drug Ther"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-007-0606-2"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-199308000-00001"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2006.02.011"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181961bff"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-199834010-00002"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e3282f0a3d3"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3468(92)90547-K"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs398"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1967.01330170070009"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/nar\/gkj067"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2014.11.005"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-014-0565-2"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-014-0632-8"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007691-199412000-00004"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp026"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-008-1269-3"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1304100112"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/FTD.0b013e318248672c"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1204000411"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03009997"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0772-5"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005237-199007000-00008"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199012000-00011"},{"issue":"5","key":"e_1_2_11_42_1","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/S0022-5223(19)34161-3","article-title":"Plasma fentanyl levels in infants undergoing extracorporeal membrane oxygenation","volume":"105","author":"Leuschen MP","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02395206"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1987.tb02649.x"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199407000-00008"},{"issue":"5","key":"e_1_2_11_46_1","doi-asserted-by":"crossref","first-page":"364","DOI":"10.4037\/ajcc1998.7.5.364","article-title":"Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation","volume":"7","author":"Franck LS","year":"1998","journal-title":"Am J Crit Care"},{"key":"e_1_2_11_47_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.12688\/f1000research.6006.1","article-title":"Ketamine infusion for patients receiving extracorporeal membrane oxygenation support: a case series","volume":"4","author":"Tellor B","year":"2015","journal-title":"F1000Res"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.3109\/15360288.2015.1101637"},{"key":"e_1_2_11_49_1","unstructured":"World Health Organization.WHO guidelines for clinical management of human infection with pandemic (H1N1) 2009; revised guidance 2009. Available fromhttp:\/\/www.who.int\/csr\/resources\/publications\/swineflu\/h1n1_guidelines_pharmaceutical_mngt.pdf. Accessed June 10 2016."},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080434"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.2005.02432.x"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/46.5.669"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.50.4.1570-1572.2006"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1191\/0267659105pf827oa"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.2165\/11319970-000000000-00000"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-200059020-00012"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e3182a84558"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1760"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-12-29"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-13-7"}],"container-title":["Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fphar.1882","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/phar.1882","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T10:33:04Z","timestamp":1761042784000},"score":1,"resource":{"primary":{"URL":"https:\/\/accpjournals.onlinelibrary.wiley.com\/doi\/10.1002\/phar.1882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,2]]},"references-count":59,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017,2]]}},"alternative-id":["10.1002\/phar.1882"],"URL":"https:\/\/doi.org\/10.1002\/phar.1882","archive":["Portico"],"relation":{},"ISSN":["0277-0008","1875-9114"],"issn-type":[{"value":"0277-0008","type":"print"},{"value":"1875-9114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,2]]},"assertion":[{"value":"2017-02-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}