Farmacokinetics and farmacodynamics of drugs used in neonates and children during Extracorporal Membanous Oxygenation (ECMO)

Children treated with ECMO recieve a wide variety of medication. There is only
sparse data available on farmacokinetics and farmacodynamics of these drugs
during ECMO. Dosing regimens are empiric or are extrapolated from data gathered
from children and adult population not on ECMO.

The objective of the study is to karacterize Pharmacokinetics and
pharmacodynamics of frequently and routinely used drugs in children and
neonates undergoing ECMO treatment and ultimately to formulate dosing regimes
for these drugs for patients undergoing ECMO treatment.

Prospective observational study. Medication will be administered following
local protocol and routine.

Patients recieve standard intensive care treatment and monitoring following
local clinical routine and protocols. Standardized bloodsamples for bloodgas
analysis, bloodcount, electrolytes, liver and kidney functiontests, and
coagulation will be preformed following normal protocol.
For this study extra bloodsamples will be drawn from the ECMO circuit or an
indwelling arterial catheter, to measure drug concentrations. On the first day
during ECMO a maximum amount of 18ml of blood will be drawn. On the following
days 6-9ml per 24 hours will drawn. MOst neonates on ECMO have a bodyweight of
3kg. Total circulating bloodvolume is 80ml/kg which comes down to 240ml for a
3kg newborn. Our neonatal ECMO system is primed with 250ml blood. Total
circulating bloodvolume of patient and ECMO system is 490ml. 18ml/day amounts
to bloodwithdrawel of less than 5% of the total circulating bloodvolume of the
patient and the ECMO system.
Urine samples from a trans urethral catheter and dialysis filtrate samples will
be drawn every 8 hours to measure drugs and drug metabolites.