title: Early enteral nutrition in adults receiving venoarterial extracorporeal membrane oxygenation: an observational case series.
abstract: BACKGROUND
  Despite its benefits, early enteral nutrition (EN) is considered controversial in critically ill patients with severe hemodynamic failure.
  
  
  OBJECTIVE
  To evaluate the tolerance and safety of early EN in a consecutive group of patients receiving venoarterial (VA) extracorporeal membrane oxygenation (ECMO) for severe hemodynamic failure.
  
  
  METHODS
  Prospective observational study performed in a cardiac surgical intensive care unit (ICU) during a 1-year period. All adult patients receiving VA ECMO for severe hemodynamic failure unresponsive to conventional therapies were included. Nutrition support was provided during the study period following the established ICU nutrition protocol. Energy target was 25 kcal/kg, to be reached over 4 days. Nutrition tolerance was defined as the ratio of delivered nutrition to target nutrition, expressed as a percentage. Special interest was made to detect possible adverse effects attributable to EN. The authors performed a descriptive statistical analysis.
  
  
  RESULTS
  Of 553 patients admitted in the cardiac surgical ICU during the study period, 7 were treated with ECMO. EN was the only nutrition source. More than 70% nutrition tolerance was achieved within the first week in all cases. No serious adverse events that could be attributable to EN were noted.
  
  
  CONCLUSIONS
  The present study shows that, under proper medical supervision, early EN is possible and safe in patients with severe hemodynamic failure receiving VA ECMO. No serious adverse events were attributable to EN. More studies are warranted to confirm these findings.
authors: Intensive Care Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain. luis_umezawa@hotmail.com
authors: Luis Daniel
authors: LD
authors: Umezawa Makikado
authors: José Luis
authors: JL
authors: Flordelís Lasierra
authors: José Luis
authors: JL
authors: Pérez-Vela
authors: Lara
authors: L
authors: Colino Gómez
authors: Enrique
authors: E
authors: Torres Sánchez
authors: Borja
authors: B
authors: Maroto Rodríguez
authors: Primitivo
authors: P
authors: Arribas López
authors: Juan Carlos
authors: JC
authors: Montejo González
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery; D055815:Young Adult