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- Title
Procainamide pharmacokinetics during extracorporeal membrane oxygenation.
- Authors
Vollmer, Nicholas J; Wittwer, Erica D; Rosenbaum, Andrew N; Wieruszewski, Patrick M
- Abstract
Procainamide is a useful agent for management of ventricular arrhythmia, however its disposition and appropriate dosing during extracorporeal membrane oxygenation (ECMO) is unknown. We report experience with continuous procainamide infusion in a critically ill adult requiring venoarterial ECMO for incessant ventricular tachycardia. Pharmacokinetic analysis of procainamide and its metabolite, N-acetylprocainamide (NAPA), was performed using serum and urine specimens. Kidney function was preserved, and sequencing of the N-acetyltransferase 2 gene revealed the patient was a phenotypic slow acetylator. Procainamide volume of distribution and half-life were calculated and found to be similar to healthy individuals. However, despite elevated serum procainamide concentrations, NAPA concentrations remained far lower in the serum and urine. The magnitude of procainamide and NAPA discordance suggested alternative contributors to the deranged pharmacokinetic profile, and we hypothesized NAPA sequestration by the ECMO circuit. Ultimately, the patient received orthotopic cardiac transplantation and was discharged home in stable condition. Procainamide should be used cautiously during ECMO, with close therapeutic drug monitoring of serum procainamide and NAPA concentrations. The achievement of therapeutic NAPA concentrations while maintaining safe serum procainamide concentrations during ECMO support may be challenging.
- Subjects
NADOLOL; PROCAINAMIDE; EXTRACORPOREAL membrane oxygenation; VENTRICULAR tachycardia; GENE expression; VENTRICULAR arrhythmia; AMINOTRANSFERASES; METABOLITES; ACETYLTRANSFERASES; PHENOTYPES; ABLATION techniques
- Publication
Perfusion, 2023, Vol 38, Issue 2, p409
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/02676591211050606