Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides

Extracorporeal membrane oxygenation (ECMO) is an emerging treatment modality associated with a high frequency of antibiotic use. However, several covariables emerge during ECMO implementation, potentially jeopardizing the success of antimicrobial therapy. These variables include but are not limited to: the increased volume of distribution, altered clearance, and adsorption into circuit components, in addition to complex interactions of antibiotics in critical care illness. Furthermore, ECMO complicates the assessment of antibiotic effectiveness as fever, or other signs may not be easily detected, the immunogenicity of the circuit affects procalcitonin levels and other inflammatory markers while disrupting the immune system. We provided a review of pharmacokinetics and pharmacodynamics during ECMO, emphasizing practical application and review of patient-, illness-, and ECMO hardware-related factors.

Automated summary

Extracorporeal membrane oxygenation (ECMO) is a treatment modality that requires frequent use of antibiotics. However, there are several variables that can affect the success of antibiotic therapy during ECMO implementation, including changes in drug distribution, clearance, adsorption into circuit components, and complex interactions with critical care illnesses. Additionally, ECMO complicates the assessment of antibiotic effectiveness due to difficulties in detecting fever or other signs, and the immunogenicity of the circuit can affect biomarkers and disrupt the immune system.