Dexmedetomidine extraction by the extracorporeal membrane oxygenation circuit: results from an in vitro study

Samantha Dallefeld, Jennifer Sherwin, Kanecia O. Zimmerman, Kevin M. Watt

Research output: Contribution to journalArticle

Abstract

Background: Dexmedetomidine is a sedative administered to minimize distress and decrease the risk of life threatening complications in children supported with extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation circuit can extract drug and decrease drug exposure, placing the patient at risk of therapeutic failure. Objective: To determine the extraction of dexmedetomidine by the extracorporeal membrane oxygenation circuit. Materials and methods: Dexmedetomidine was studied in three closed-loop circuit configurations to isolate the impact of the oxygenator, hemofilter, and tubing on circuit extraction. Each circuit was primed with human blood according to standard practice for Duke Children’s Hospital, and flow was set to 1 L/min. Dexmedetomidine was dosed to achieve a therapeutic concentration of ~600 pg/mL. Dexmedetomidine was added to a separate tube of blood to serve as a control and evaluate for natural drug degradation. Serial blood samples were collected over 24 hours and concentrations were quantified with a validated assay. Drug recovery was calculated at each time point. Results: Dexmedetomidine was highly extracted by the oxygenator evidenced by a mean recovery of 62-67% at 4 hours and 23-34% at 24 hours in circuits with an oxygenator in-line. In contrast, mean recovery with the oxygenator removed was 96% at 4 hours and 93% at 24 hours. Dexmedetomidine was stable over time with a mean recovery in the control samples of 102% at 24 hours. Conclusion: These results suggest dexmedetomidine is extracted by the oxygenator in the extracorporeal membrane oxygenation circuit which may result in decreased drug exposure in vivo.

Original languageEnglish (US)
JournalPerfusion (United Kingdom)
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Dexmedetomidine
Extracorporeal Membrane Oxygenation
Oxygenation
Oxygenators
drug
Membranes
Networks (circuits)
Recovery
Blood
Pharmaceutical Preparations
Tubing
In Vitro Techniques
Hypnotics and Sedatives
Assays
Degradation

Keywords

  • dexmedetomidine
  • extracorporeal membrane oxygenation
  • extracorporeal membrane oxygenation
  • precedex
  • sedative extraction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Dexmedetomidine extraction by the extracorporeal membrane oxygenation circuit : results from an in vitro study. / Dallefeld, Samantha; Sherwin, Jennifer; Zimmerman, Kanecia O.; Watt, Kevin M.

In: Perfusion (United Kingdom), 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Dexmedetomidine is a sedative administered to minimize distress and decrease the risk of life threatening complications in children supported with extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation circuit can extract drug and decrease drug exposure, placing the patient at risk of therapeutic failure. Objective: To determine the extraction of dexmedetomidine by the extracorporeal membrane oxygenation circuit. Materials and methods: Dexmedetomidine was studied in three closed-loop circuit configurations to isolate the impact of the oxygenator, hemofilter, and tubing on circuit extraction. Each circuit was primed with human blood according to standard practice for Duke Children’s Hospital, and flow was set to 1 L/min. Dexmedetomidine was dosed to achieve a therapeutic concentration of ~600 pg/mL. Dexmedetomidine was added to a separate tube of blood to serve as a control and evaluate for natural drug degradation. Serial blood samples were collected over 24 hours and concentrations were quantified with a validated assay. Drug recovery was calculated at each time point. Results: Dexmedetomidine was highly extracted by the oxygenator evidenced by a mean recovery of 62-67{\%} at 4 hours and 23-34{\%} at 24 hours in circuits with an oxygenator in-line. In contrast, mean recovery with the oxygenator removed was 96{\%} at 4 hours and 93{\%} at 24 hours. Dexmedetomidine was stable over time with a mean recovery in the control samples of 102{\%} at 24 hours. Conclusion: These results suggest dexmedetomidine is extracted by the oxygenator in the extracorporeal membrane oxygenation circuit which may result in decreased drug exposure in vivo.",
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