[Expert consensus on drug adjustment during extracorporeal membrane oxygenation support (2025)].

Extracorporeal membrane oxygenation (ECMO) technology is an important life support method for critically ill patients. A large number of studies have found that ECMO can change the pharmacokinetic (PK) parameters of critically ill patients, thereby affecting the drug effect in vivo. However, there is still a lack of recommendations for the adjustment of commonly used drugs during ECMO support in China, and the selection or dosage adjustment of drugs during ECMO support is not clear. Therefore, a multidisciplinary group of domestic experts in clinical pharmacy and critical care medicine was established by Critical Care Medicine Committee of China International Exchange and Promotive Association for Medical and Health Care, and Hospital Pharmacy Committee of China Pharmaceutical Association, to develop the Expert consensus on drug adjustment during extracorporeal membrane oxygenation support (2025). Eight clinical issues of drug adjustment during ECMO support were discussed in this consensus: (1) Why does the patient's demand for drug dosage change during ECMO support? (2) What factors are related to the degree of drug loss during ECMO support? (3) Considering the features of drugs, which types of drugs may need to be adjusted during ECMO support? (4) How to adjust the dosage when using antibacterial drugs during ECMO support? (5) How to adjust antifungal drugs during ECMO support? (6) Does ECMO support change patients' dosage requirements for antiviral drugs? (7) How to adjust sedative and analgesic drugs during ECMO support? (8) Does ECMO support affect the dosage requirement of vasoactive agents? Eighteen consensus are elaborated based on the latest clinical evidence, aiming to provide recommendations for drug adjustment in critically ill patients receiving ECMO support to ensure the safety and effectiveness of medication.