165: ENTERAL NUTRITION ADEQUACY ON ECMO AND ITS ASSOCIATION WITH END-ORGAN FUNCTION

Abstract

Introduction: Children with heart disease requiring ECMO support are at risk for nutritional deterioration. The provision of enteral nutrition (EN) is challenging due to several factors. We explored the relationship between EN adequacy and change in the pediatric sequential organ failure assessment (pSOFA) score in children with heart disease supported on ECMO. Methods: Children (≤21yo) with congenital or acquired heart disease requiring ECMO support between 1/1/2013 to 12/31/2020 at a single institution were included. Data was acquired from our electronic medical record, dietitian record and local ECMO and surgical databases. Change in pSOFA score was calculated with hemodynamic and laboratory values at the time of cannulation and decannulation. Adequacy was defined as total intake divided by goal intake as defined by the Schofield equation. Results: Two hundred and fifty-nine children were evaluated over an 8-year period; 54% (n=140) were male with a median age at admission of 5.3 [0, 33.6] months. Surgical admissions were more common (n=173) than medical. Most children had complex biventricular (n=102) and single ventricle (n=98) physiology. Admission weight-for-age Z-score (WAZ) was -0.9 [-2.3, -0.2] with a median change in WAZ during admission of -0.5 [-1.6, 0]. Venoarterial (VA) ECMO was nearly the universal mode of support (n=255) with a mean duration of support of 6.7 ± 12.3 days. Twenty-nine percent (n=74) of patients were provided EN while on ECMO. Median change in pSOFA score was 5 [0, 13]. Patients provided EN had a median change in pSOFA score of 4 [-0.3, 11] versus those who did not receive EN 6 [1, 13]; p=0.62. Median EN energy adequacy was 0 [0, 1] %. EN energy adequacy was not associated with change in pSOFA (p=0.37). Conclusions: EN provision on ECMO is not associated with worsening pSOFA scores. Despite the concerns that arise surrounding labile hemodynamics on ECMO, there is no evidence of worsening end organ function when provided EN. Energy adequacy on ECMO remains low and prohibits the ability to determine a significant association between adequacy and changes in end organ function. Further research is needed to determine the best ways to optimize EN adequacy knowing that there is no detriment to end organ function with its initiation.