Impact of ex-vivo extracorporeal membrane oxygenation circuitry on daptomycin

Author:

Cies Jeffrey J.123ORCID,Moore Wayne S.1,Giliam Nadji2,Low Tracy2,Enache Adela4,Chopra Arun156

Affiliation:

1. The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA, USA

2. St. Christopher’s Hospital for Children, Philadelphia, PA, USA

3. Drexel University College of Medicine, Philadelphia, PA, USA

4. Atlantic Diagnostic Laboratories, Bensalem, PA, USA

5. NYU Langone Medical Center, New York, NY, USA

6. NYU School of Medicine, New York, NY, USA

Abstract

Background: The objective was to determine the alterations of daptomycin (DAP) in a contemporary neonatal/pediatric (1/4-inch) and adolescent/adult (3/8-inch) extracorporeal membrane oxygenation (ECMO) circuit including the Quadrox-i® oxygenator. Methods: Quarter-inch and 3/8-inch, simulated, closed-loop, ECMO circuits were prepared with a Quadrox-i pediatric and Quadrox-i adult oxygenator and blood primed. A one-time dose of DAP was administered into the circuit and serial pre- and post-oxygenator concentrations were obtained at 0-5 minutes and 1, 2, 3, 4, 5, 6 and 24-hour time points. DAP was also maintained in a glass vial and samples were taken from the vial at the same time periods for control purposes to assess for spontaneous drug degradation Results: For both the 1/4-inch and 3/8-inch circuits, there was no significant DAP loss at 24 hours. Additionally, the reference DAP concentrations remained relatively constant during the entire 24-hour study period. Conclusion: This ex-vivo investigation demonstrated no significant DAP loss within an ECMO circuit with both sizes of the Quadrox-i oxygenator at 24 hours. Therapeutic concentrations of DAP in the setting of ECMO may be anticipated with current recommended doses, depending on the amount of extracorporeal volume needed for circuit maintenance in comparison to the patient’s apparent volume of distribution. Additional studies with a larger sample size are needed to confirm these findings.

Funder

Merck Sharp and Dohme

Publisher

SAGE Publications

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology Nuclear Medicine and imaging,General Medicine

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