{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:30:38Z","timestamp":1777915838113,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T00:00:00Z","timestamp":1633564800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>Procainamide is a useful agent for management of ventricular arrhythmia, however its disposition and appropriate dosing during extracorporeal membrane oxygenation (ECMO) is unknown. We report experience with continuous procainamide infusion in a critically ill adult requiring venoarterial ECMO for incessant ventricular tachycardia. Pharmacokinetic analysis of procainamide and its metabolite, N-acetylprocainamide (NAPA), was performed using serum and urine specimens. Kidney function was preserved, and sequencing of the N-acetyltransferase 2 gene revealed the patient was a phenotypic slow acetylator. Procainamide volume of distribution and half-life were calculated and found to be similar to healthy individuals. However, despite elevated serum procainamide concentrations, NAPA concentrations remained far lower in the serum and urine. The magnitude of procainamide and NAPA discordance suggested alternative contributors to the deranged pharmacokinetic profile, and we hypothesized NAPA sequestration by the ECMO circuit. Ultimately, the patient received orthotopic cardiac transplantation and was discharged home in stable condition. Procainamide should be used cautiously during ECMO, with close therapeutic drug monitoring of serum procainamide and NAPA concentrations. The achievement of therapeutic NAPA concentrations while maintaining safe serum procainamide concentrations during ECMO support may be challenging.<\/jats:p>","DOI":"10.1177\/02676591211050606","type":"journal-article","created":{"date-parts":[[2021,10,7]],"date-time":"2021-10-07T09:34:42Z","timestamp":1633599282000},"page":"409-413","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Procainamide pharmacokinetics during extracorporeal membrane oxygenation"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3400-3811","authenticated-orcid":false,"given":"Nicholas J","family":"Vollmer","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica D","family":"Wittwer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9202-0233","authenticated-orcid":false,"given":"Andrew N","family":"Rosenbaum","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5871-5186","authenticated-orcid":false,"given":"Patrick M","family":"Wieruszewski","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Mayo Clinic, Rochester, MN, USA"},{"name":"Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA"},{"name":"Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,10,7]]},"reference":[{"key":"bibr1-02676591211050606","first-page":"e506","volume":"133","author":"Page RL","year":"2016","journal-title":"Circulation"},{"key":"bibr2-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1007\/BF00558433"},{"key":"bibr3-02676591211050606","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-197803020-00001"},{"key":"bibr4-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(80)90016-8"},{"key":"bibr5-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1974.tb01696.x"},{"key":"bibr6-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0018507"},{"key":"bibr7-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1002\/cpt1975176722"},{"key":"bibr8-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1007\/BF00606561"},{"key":"bibr9-02676591211050606","unstructured":"Procainamide [prescribing information]. Lake Forest, IL: Hospira Inc, February 2019."},{"key":"bibr10-02676591211050606","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-197702060-00001"},{"key":"bibr11-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1007\/BF01059442"},{"key":"bibr12-02676591211050606","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198409060-00004"},{"key":"bibr13-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2012.02.013"},{"key":"bibr14-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1007\/BF00716367"},{"key":"bibr15-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1984.tb14507.x"},{"key":"bibr16-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-017-1644-y"},{"key":"bibr17-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1097\/01.ccm.0000528880.07771.67"},{"key":"bibr18-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1592\/phco.26.12.1687"},{"key":"bibr19-02676591211050606","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1051\/ject\/202153068","volume":"53","author":"McDaniel CG","year":"2021","journal-title":"J Extra Corpor Technol"},{"key":"bibr20-02676591211050606","doi-asserted-by":"publisher","DOI":"10.1208\/s12248-011-9290-9"}],"container-title":["Perfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591211050606","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02676591211050606","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02676591211050606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:30:57Z","timestamp":1777656657000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02676591211050606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,7]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1177\/02676591211050606"],"URL":"https:\/\/doi.org\/10.1177\/02676591211050606","relation":{},"ISSN":["0267-6591","1477-111X"],"issn-type":[{"value":"0267-6591","type":"print"},{"value":"1477-111X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,7]]}}}