Jeffrey Cies, BCPS, MPH, PharmD
Clinical Coordinator and Critical Care Pharmacist
St. Christopher's Hospital for Children
Philadelphia, Pennsylvania
Disclosure information not submitted.
Wayne Moore, PharmD
Clinical Pharmacist
Nemours Cardiac Center, United States
Disclosure information not submitted.
Jillian Deacon, RN
ECMO Coordinator
St. Christopher's Hospital for Children, United States
Disclosure information not submitted.
Adela Enache, MS
MS
Atlantic Diagnostic Laboratories, United States
Disclosure information not submitted.
Arun Chopra, MD
Chief
NYU Langone Medical Center and School of Medicine, United States
Disclosure information not submitted.
Title: Oxygenator Impact on Peramivir in Extracorporeal Membrane Oxygenation Circuits
Intro:ECMO is a treatment modality known to alter drug pharmacokinetics (PK). The purpose of this study was to determine the impact of the Quadrox-i pediatric and adult oxygenators on the PK of peramivir (PRV) in contemporary ECMO circuits.
Methods: Two 1/4-in. and two 3/8-in. closed loop ECMO circuits were prepared using custom tubing with polyvinylchloride and superTygon® (Medtronic Inc., Minneapolis, MN) and a Quadrox-i adult or pediatric oxygenator (Maquet). Additionally, two 1/4-in. and two 3/8-in. closed loop ECMO circuits wer assembled without an oxygenator in series. The circuits were carbon dioxide primed, evacuated, and then crystalloid primed. After debubbling the circuit, 50 mL of 5% albumin was added and then displaced with the priming solution (whole blood), tromethamine, heparin, and calcium gluconate. The circuit pH was adjusted to a range of 7.35-7.45. The closed-loop design was established by connecting the ends of the arterial and venous cannulae to a reservoir bag, allowing continuous flow of the priming fluid around the circuit. PRV was added to the circuit and levels were obtained pre-and post-oxygenator at the following time intervals; 5 mins, 1, 2, 3, 4, 5, 6, 8, 12, and 24 hrs. PRV was also maintained in a glass vial and samples obtained at the same time periods for control purposes. PRV samples were analyzed by liquid chromatography tandem mass spectrometry.
Results: For the 3/8-in. circuits with an oxygenator, there was < 15% PRV loss during the study period. For the 3/8-in. circuits without an oxygenator, there was < 3% PRV loss during the study period. For the 1/4-in. circuits with an oxygenator, there was < 15% PRV loss during the study period. For the 1/4-in. circuits without an oxygenator, there was < 3% PRV loss during the study period.
Conclusion: There was no significant PRV loss over the 24-hour study period in either the 1/4-in. or 3/8-in circuit, regardless of the presence of the oxygenator. The concentrations obtained pre- and post-oxygenator appeared to approximate each other suggesting there may be no drug loss via the oxygenator. This preliminary data suggests PRV dosing may not need to be adjusted for concern of drug loss via the oxygenator. Additional single and multiple dose studies are needed to validate these findings.