Introduction: The optimal weight-based vancomycin dose to achieve goal trough concentrations in patients receiving both ECMO and CVVHDF is not well described. This analysis aimed to describe vancomycin dosing and rates of target attainment in this patient population. Methods: This was a retrospective analysis of adult ECMO patients at Duke University Hospital receiving 3 or more consecutive vancomycin doses and CVVHDF for renal failure who underwent therapeutic drug monitoring between 2023 and 2025. Patients with trough concentrations drawn at inappropriate times, changes in dialysate rates within 72 hours of trough concentrations, interruptions in CVVHDF for >4 hours, changes in vancomycin maintenance doses, and receipt of diuretics were excluded. The primary outcome was the percentage of target trough concentration attainment (10-20 mcg/mL). Results: In the 22 patients included, the rate of target attainment was 82% (n=18) with a median trough concentration of 13.25 mcg/mL (10.6-15). Patients with therapeutic trough concentrations received a median vancomycin dose of 11.2 mg/kg (9.5-13.1) actual body weight. The median dialysate flow rate was 12.6 (11.1-14.2) mL/kg/hr and patients had a median BMI 28.9 (25.9-32.6) kg/m2. Two patients each had subtherapeutic (20 mcg/mL) trough concentrations. The indication for vancomycin was prophylaxis in 59% and treatment in 41% of patients. The median duration of concomitant vancomycin and CVVHDF prior to checking trough concentrations was 102 hours (86-180). Patients were dialyzed with either a HF1400 (n=12) or M100 (n=10) filter. Conclusions: In patients requiring vancomycin while receiving both ECMO and CVVHDF therapy, a 11.2 mg/kg dose administered every 24 hours achieved high rates of target trough attainment.
Diane P Emery (Sun,) studied this question.