Objective: To describe the administration of vincristine and daunorubicin to a 14-year-old girl requiring ECMO support due to a non-Hodgkin’s lymphoma mediastinal mass.
Design and Setting: Patient case report in an 18-bed level 1 medical-surgical Pediatric Intensive Care Unit (PICU) in a free standing children hospital.
Patients: A 14-year-old adolescent female admitted to the PICU. Each author’s Institutional Review Board deemed this project exempt.
Results: A 14-year-old previously healthy adolescent girl presented with a 3 month history of progressively worsening respiratory difficulties. A large mediastinal mass and pleural effusion were found on computerized tomography (CT) scan. Soon after, the patient had multiple cardiac arrests and resuscitations and was deployed on ECMO. The treatment protocol for her lymphoma included high dose methylprednisolone, vincristine, and daunorubicin. The administration of all medications for this patient, including her chemotherapeutic agents, was done during concurrent use of ECMO and hemofiltration dialysis.
Conclusion: Administration of vincristine during ECMO has rarely been described, and this is the first description of use of daunorubicin with ECMO. Since daunorubicin has a rapid and extensive distribution into tissues, a large volume of distribution, modest protein binding, and mainly hepatic metabolism, dosing adjustment was not necessary during ECMO. Vincristine is also rapidly and extensively distributed throughout the body, has a large volume of distribution, and undergoes hepatic metabolism. However, because of its relatively large protein binding and potential for binding in the membrane oxygenator, the vincristine dose was increased by 25% over the standard protocol. There is little published information regarding dosing of medications during ECMO, especially daunorubicin and vincristine, and even less during ECMO with concurrent hemofiltration dialysis. Additional studies are needed to optimize medication dosing during ECMO.