Drugs, ECMO, & Rubber Ducks

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Lauren Igneri
Lauren Igneri
Critical care pharmacist and proud Rutgers University graduate. Enjoys rock climbing, cycling, travel, and lively discussions on the finer points of pharmacokinetics and critical care over a beer with friends.

The Pre-brief

Expected Effects if ECMO on Antimicrobial Pharmacokinetics/Pharmacodynamics

Determining the most appropriate dose of antimicrobials in the setting of critical illness is
challenging due to altered blood flow to vital organs affecting drug metabolism and elimination.
The addition of extracorporeal membrane oxygenation support will further impact drug
pharmacokinetics (PK) and pharmacodynamics (PD). Here, the effects of ECMO on Antimicrobial
PK/PD are described using a simplified model.


  1. Dzierba AL, Abrams D, Brodie D. Medicating patients during extracorporeal membrane oxygenation: the evidence is building. Crit Care. 2017; 66:1-7.

  2. Lequier L, Horton SB, McMullen DM, et al. Extracorporeal membrane oxygenation circuitry. Pediatr Crit Care Med. 2013; 14(5):1-10.

  3. Donadello K, Antonucci E, Cristallini S, et al. B-lactam pharmacokinetics during extracorporeal membrane oxygenation therapy: a case-control study. Int J Antimicrob Agents. 2015; 45:278-82.

  4. Ha MA, Sieg AC. Evaluation of altered drug pharmacokinetics in critically ill adults receiving extracorporeal membrane oxygenation. Pharmacotherapy. 2017; 37(2):221-35.

  5. Blot SI, Pea F, Lipman J. The effect of pathophysiology on pharmacokinetics in the critically ill patient – Concepts appraised by the example of antimicrobial agents. Adv Drug Deliv Rev. 2014; 77(20):3-11.


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