Consider Heightened Awareness of Propofol Infusion Syndrome after Extracorporeal Membrane Oxygenation (ECMO) Decannulation

THE PHARMACOKINETICS of sedative drugs can be affected by multiple factors in critically ill patients. Moreover, in patients undergoing extracorporeal membrane oxygenation (ECMO), data regarding appropriate dosing of sedative drugs is limited. ECMO is an invasive management for those who have failed conservative treatment for refractory respiratory or cardiac failure. Currently there are no consensus guidelines regarding sedation strategies for these patients. However, it is understood that lipophilic agents such as propofol can be sequestered in the extracorporeal circuit (ie, tubing and oxygenators), resulting in reduced plasma drug levels and the need for higher doses to achieve the same clinical effect seen in non-ECMO patients. Further complicating matters, the configuration of ECMO may also affect medication requirements. Patients on venovenous (VV) ECMO appear to need higher doses as compared with patients on venoarterial (VA) ECMO.

The authors describe an interesting case of propofol infusion syndrome developing in a patient who was recently decannulated from VA ECMO.