Pediatric ECMO and Cefepime

In critically ill patients not receiving extracorporeal membrane oxygenation (ECMO), pharmacokinetic (PK) studies have demonstrated significant changes to drug exposure through interactions between the patient, pathology, and the drug. The ECMO system introduces additional variables, which are inherent to the circuit itself, as well as the systemic inflammation that results from use of an extracorporeal circuit. The amount of variability in drug disposition and pharmacokinetics with use of ECMO is largely unknown. The objective of this study was to gain preliminary data on the impact of ECMO on the pharmacokinetics of cefepime administered as standard of care to infants. A PK model was developed to evaluate cefepime disposition differences due to ECMO. This study found that cefepime clearance was reduced in pediatric patients treated with extracorporeal membrane oxygenation compared with previously reported values in children not receiving extracorporeal membrane oxygenation.