Disposition of gentamicin and amikacin in extracorporeal membrane oxygenation using a heparin-coated filter: An in vitro assessment

Abstract

Disposition of gentamicin and amikacin during extracorporeal membrane oxygenation has not been addressed in in vitro models. The HLS Advanced 7.0® circuit with the Cardio Help® monitor, Getinge, was used. The 5-L central compartment (CC) was loaded with gentamicin and amikacin at a targeted concentration of 40 and 80 mg/L in the same bag prior connection to the circuit. Samples were collected in the CC, the inlet and outlet ports from 15 min to 6 h post-connection. Pharmacokinetic analyses were performed using the NeckEpur® method. Analysis of results of gentamicin and amikacin showed in the filter-pump block (i) the extremely low value of the extraction coefficients, (ii) similar values of the areas under the curve (AUCs) at the inlet and outlet ports, (iii) using the Wilcoxon matched pairs signed rank test no significant differences of the inlet-outlet concentrations in the filter-pump. In the whole system (i) the amounts recovered in the CC at the end of the 6-h session were not significantly different from the initial values, (ii) the extremely low values of the total clearance of gentamicin and amikacin from the CC in comparison with the measured simulated blood flowrate, (iii) the lack of significant time-concentration interactions in the CC and the inlet and outlet ports. These findings allow concluding no detectable adsorption of gentamicin and amikacin occurred in the HLS Advanced 7.0 circuit.

Elimination of cefotaxime using polysulfone and polyacrylonitrile-derived filters: An in vitro assessment

“…Samplings were performed, as previously reported, [1][2][3][4][5] in the central compartment (CC), at the entry (C in ), exit (C out ) of the filter, at the effluent tubing (C effl ), and in the 5 L effluent (C effl cum ). at 0, +15, +30, +45, and +60 min, and then at +2, 3, 4, and 6 h. Cumulative effluents were sampled at the time the bag was filled and needed to be changed.…”

Refurbishment of Extracorporeal Life Support Oxygenators in the Context of In Vitro Testing

“…Depending on therapy and patient, most oxygenators have a static filling volume between 50 and 300 ml, a functional surface area between 0.3 and 2 m 2 , and are operated with blood flow rates between 0.5 and 7 l/min. [1][2][3] Typically, ECMO runs have a duration between a few days up to around 30 days, at which time most oxygenators would have to be replaced due to degeneration. 4 The oxygenators are single use devices and cost between a few hundred and a few thousand Dollars per unit.…”