Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults: a retrospective audit of 86 patients.
OBJECTIVE
Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support critically ill patients with severe cardiac and/or respiratory failure. It has been claimed that the resulting haemodynamic alterations, particularly in venoarterial ECMO, mean that enteral feeding is unsafe and/or poorly tolerated. This study aims to investigate this question and to identify any barriers to optimal nutrition.


METHODS
Data were retrospectively collected for 86 patients who received ECMO between January 2007 and July 2012 in a tertiary critical care unit/ECMO referral centre. All were fed using existing protocols that emphasise early enteral feeding in preference over parenteral or delayed enteral nutrition.


RESULTS
Thirty-one patients required ECMO for cardiac failure, and all of these received venoarterial ECMO; the remainder received venovenous ECMO. Enteral feeds started for all patients at average 13.1 h [standard deviation (SD) 16.7 h] after ICU admission, reaching goal rate on day 2.6 (SD 1.4). Thirty-three patients experienced significant feeding intolerance during the first 5 days, but of these 20 were managed effectively with prokinetic medications; 18 required parenteral nutrition to supplement inadequately tolerated tube feeds. Intolerance did not differ between ECMO modes. Overall patients tolerated 79.7% of goal nutrition each day in the first 2 weeks.


CONCLUSIONS
Enteral feeding can be well tolerated by patients who are receiving ECMO, whether in venovenous or venoarterial mode. ECMO should not exclude patients from receiving the well-documented benefits of early enteral feeding in critical illness.
Intensive Care Service, Critical Care Dietitian, Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia, suzie.ferrie@sswahs.nsw.gov.au.
Suzie
S
Ferrie
Robert
R
Herkes
Paul
P
Forrest
D018806:APACHE; D000328:Adult; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D008297:Male; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D016896:Treatment Outcome