871: The Effect of Ecmo on Procainamide Infusion Dosing and Serum Concentrations

Damhoff, Heather; Combs, Kyle; Johnsrude, Christopher L.; Lau, Kai

doi:10.1097/01.ccm.0000528880.07771.67

Cited by 2 publications

(1 citation statement)

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“…Indeed, serum procainamide concentrations nearly doubled in a neonate following separation from ECMO. 17 In contrast, this phenomenon was not observed in our case, as the calculated volume of distribution during ECMO was in fact lower than the average adult not on ECMO. One explanation may have been due to artifact of overall lower total body clearance in our patient, as the volume of distribution is calculated, not measured.…”

Section: Discussioncontrasting

confidence: 82%

Procainamide pharmacokinetics during extracorporeal membrane oxygenation

et al. 2021

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Procainamide is a useful agent for management of ventricular arrhythmia, however its disposition and appropriate dosing during extracorporeal membrane oxygenation (ECMO) is unknown. We report experience with continuous procainamide infusion in a critically ill adult requiring venoarterial ECMO for incessant ventricular tachycardia. Pharmacokinetic analysis of procainamide and its metabolite, N-acetylprocainamide (NAPA), was performed using serum and urine specimens. Kidney function was preserved, and sequencing of the N-acetyltransferase 2 gene revealed the patient was a phenotypic slow acetylator. Procainamide volume of distribution and half-life were calculated and found to be similar to healthy individuals. However, despite elevated serum procainamide concentrations, NAPA concentrations remained far lower in the serum and urine. The magnitude of procainamide and NAPA discordance suggested alternative contributors to the deranged pharmacokinetic profile, and we hypothesized NAPA sequestration by the ECMO circuit. Ultimately, the patient received orthotopic cardiac transplantation and was discharged home in stable condition. Procainamide should be used cautiously during ECMO, with close therapeutic drug monitoring of serum procainamide and NAPA concentrations. The achievement of therapeutic NAPA concentrations while maintaining safe serum procainamide concentrations during ECMO support may be challenging.

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Section: Discussioncontrasting

confidence: 82%