196 N . Khurana et al .: J Extra Corpor Technol 2023 , 55 , 194 – 196
circuit had an adult oxygenator ( common practice in pediatric ECMO centers ). Because adsorption is dependent in part on flow rate in an ex vivo circuit , in order to translate this to an adult ECMO circuit , higher doses of propofol would be required . Another potential limitation is that propofol rapidly distributes out of the plasma when administered to a patient , and it is unknown if those low concentrations in the plasma would be sufficient to saturate the circuit . There are some concerns that administering a lipophilic drug directly to an ECMO circuit can increase clotting and impair oxygenator function [ 10 ]. Another unknown is the possibility of the circuit acting as a reservoir and leading to the leaching of the drug back into circulation and causing toxicity [ 5 ]. Consequently , additional ex vivo and in vivo work is required before dosing propofol directly to the circuit can be routinely recommended .
Conclusion
In summary , this is the first study to definitively show that adsorption by the ECMO circuit is saturable after an infusion dose is administered . Furthermore , these results demonstrate the potential of removing adsorption as a source of altered drug exposure by saturating the circuit . Additional work is needed to determine the optimal dose and if direct administration to the circuit impacts circuit function .
Acknowledgements . This research was conducted under a Pilot Award funded by the University of Utah Clinical and Translational Science Institute ( CTSI ).
Conflict of interest The authors declare no conflict of interest .
Funding
This work was funded by the University of Utah Clinical and Translational Science Institute Pilot Award program .
Data availability The research data are available on request from the authors .
Author contributions
Nitish Khurana : Conceptualization , Data Curation , Formal Analysis , Funding Acquisition , Investigation , Methodology ,
Validation , Writing – original draft ; Till Süenner : Investigation , Methodology ; Carina Imburgia : Investigation , Methodology ; Venkata Yellepeddi : Conceptualization , Funding Acquisition , Methodology , Writing – review and editing ; Hamidreza Ghandehari : Conceptualization , Funding Acquisition , Methodology , Writing – review and editing , Supervision ; Kevin M . Watt : Conceptualization , Funding Acquisition , Methodology , Writing – review and editing , Supervision .
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Cite this article as : Khurana N , Sünner T , Hubbard O , Imburgia CE , Yellepeddi V , Ghandehari H & Watt KM . Direct and continuous dosing of propofol can saturate Ex vivo ECMO circuit to improve propofol recovery . J Extra Corpor Technol 2023 , 55 , 194 – 196