Therapeutic drug monitoring of valproic acid in extracorporeal membrane oxygenation

Megan F. Hunt, Katharine T. Clark, Michael C. Grant, Chun Woo Choi, Glenn Whitman, Sung Min Cho, Salia Farrokh

Research output: Contribution to journalArticlepeer-review


Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for those in cardiopulmonary failure, including post-cardiac arrest. Despite a high volume of ECMO patients using anti-seizure medication, there is a paucity of data concerning the dosing, levels, and clinical scenarios for their use. Case Report: We present three cases of ECMO patients post-PEA arrest who were on valproic acid (VPA) for treatment of seizure and/or myoclonus. The total and free levels of VPA are reported. Discussion: The trough levels are consistent throughout therapy, suggesting VPA is not significantly removed by the ECMO circuitry. Although the total serum levels remained below the toxic range, the free level was elevated in two patients. These patients did not develop signs of toxicity. Conclusion: VPA may be an effective anti-seizure medication in ECMO patients. Free VPA levels should be more readily available to better quantify efficacy or toxicity, especially in ECMO patients.

Original languageEnglish (US)
Pages (from-to)868-872
Number of pages5
JournalPerfusion (United Kingdom)
Issue number8
StatePublished - Nov 2021


  • Depakote
  • ECMO
  • extracorporeal membrane oxygenation
  • myoclonus
  • seizure
  • valproic acid

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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