Critically ill patients requiring catecholamine infusion may require extracorporeal membrane oxygenation (ECMO) support. Initiating ECMO support may affect the circulating catecholamine levels, which directly influences the circulatory support. We measured the timed plasma levels of epinephrine, norepinephrine, and dopamine infused at a constant rate in pigs supported on the ECMO. Plasma levels of catecholamines decreased at 10 minutes after the initiation of ECMO, followed by a return to steady-state concentrations for the next 2 hours. Catecholamines levels in patients initiated on ECMO may follow similar changes.

While ECMO provides essential life-sustaining circulatory support, it also introduces critical variables that directly alter the pharmacokinetics through drug distribution,¹ drug adsorption,² and drug elimination.³ Literature supporting the altered drug metabolism in patients supported with ECMO is available for different antibiotics,¹ analgesics,⁴ and sedatives,⁵ commonly used in critical care units. However, the literature on the effects of ECMO on commonly used inotropes (epinephrine [EPI], dopamine [DOP]) and vasopressors (norepinephrine [NE]) is lacking. We examined the plasma levels of commonly used inotropes and vasopressor medications in pigs supported on the ECMO circuit.