System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Review Epublish

PubMed: 42907944 DOI: 10.1186/s44158-026-00408-5

Pharmacology of vasopressors and inotropes during extracorporeal membrane oxygenation.

J Anesth Analg Crit Care 6(1)

Authors: Hannah M Brinkman, Jamel P Ortoleva, Abigail G Elliott, Dominic V Pisano, Juan G Ripoll, Nathaniel J Martin, Troy G Seelhammer, Mary A Kraybill, Omar Elmadhoun, Alice Bottussi, Marc Leone, Erica D Wittwer, Elena Giovanna Bignami, Jacopo D'Andria Ursoleo, Patrick M Wieruszewski

Affiliations

  • Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
  • Department of Anesthesiology, Boston Medical Center, Boston, MA, USA.
  • Deparment of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
  • Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
  • Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Department of Anesthesia and Intensive Care Unit, Nord Hospital, Assistance Publique- Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France.
  • Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Abstract

BACKGROUND

This review aims to provide a concise summary of hemodynamic considerations and the pharmacology and current evidence of vasoactive support, including inotropes and vasopressors, during extracorporeal membrane oxygenation (ECMO) support.

MAIN TEXT

Patients requiring ECMO for cardiogenic shock or cardiac arrest have a high mortality rate. Despite advancements in medical and mechanical therapies, optimal use of vasoactive in patients receiving venoarterial ECMO is not well defined. Venoarterial ECMO introduces unique hemodynamic disturbances and considerations for the provision of vasoactive medications. Many different pharmacotherapies with varying inotropic, vasoconstrictive, and vasodilating effects are available and include catecholamine and non-catecholamine agents. Mechanisms and level of evidence vary based on agent, yet distinct characteristics may make certain agents more attractive than others depending on the clinical situation faced during ECMO.

CONCLUSIONS

A nuanced understanding of receptor pharmacology and ECMO specific considerations is essential to tailor the vasoactive strategy in this unique population.

MeSH

Extracorporeal Membrane Oxygenation, Pharmacology, Catecholamines, Therapeutics, Membranes, Hemodynamics