Pharmacology of vasopressors and inotropes during extracorporeal membrane oxygenation.
8 affiliations
- 1Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
- 2Department of Anesthesiology, Boston Medical Center, Boston, MA, USA.
- 3Deparment of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
- 4Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
- 5Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- 6Department of Anesthesia and Intensive Care Unit, Nord Hospital, Assistance Publique- Hôpitaux de Marseille (AP-HM), Aix Marseille Université, Marseille, France.
- 7Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
- 8Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. [email protected].
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.
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BibTeX
@article{brinkman2026pharmacology,
title = {{Pharmacology of vasopressors and inotropes during extracorporeal membrane oxygenation.}},
author = {Hannah M Brinkman and Jamel P Ortoleva and Abigail G Elliott and Dominic V Pisano and Juan G Ripoll and Nathaniel J Martin and Troy G Seelhammer and Mary A Kraybill and Omar Elmadhoun and Alice Bottussi and Marc Leone and Erica D Wittwer and Elena Giovanna Bignami and Jacopo D'Andria Ursoleo and Patrick M Wieruszewski},
journal = {Journal of anesthesia, analgesia and critical care},
year = {2026},
month = jul,
doi = {10.1186/s44158-026-00408-5},
url = {https://europepmc.org/article/MED/42907944},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pharmacology of vasopressors and inotropes during extracorporeal membrane oxygenation.
AU - Hannah M Brinkman
AU - Jamel P Ortoleva
AU - Abigail G Elliott
AU - Dominic V Pisano
AU - Juan G Ripoll
AU - Nathaniel J Martin
AU - Troy G Seelhammer
AU - Mary A Kraybill
AU - Omar Elmadhoun
AU - Alice Bottussi
AU - Marc Leone
AU - Erica D Wittwer
AU - Elena Giovanna Bignami
AU - Jacopo D'Andria Ursoleo
AU - Patrick M Wieruszewski
PY - 2026
DA - 2026/07/01
JO - Journal of anesthesia, analgesia and critical care
DO - 10.1186/s44158-026-00408-5
UR - https://europepmc.org/article/MED/42907944
AB - 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.
SN - 2731-3786
ER -