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Abstract

Introduction: Nutrition is a key element of recovery from the state of critical illness. Little is known about nutritional adequacy in patients supported on extracorporeal membrane oxygenation (ECMO) for severe cardio-respiratory dysfunction. There are theoretical concerns with the timing and adequacy of calorie feedings in a hyper-metabolic state and the effect on morbidity and mortality. Hypothesis: It is assumed that adequate early nutrition improves outcomes in this subset of patients. Methods: A retrospective IRB approved review was conducted of all patients supported on ECMO from 7/10 to 6/12. The patients were divided into 2 groups, survivors and non-survivors. Age, sex, preoperative comorbidities, type and duration of ECMO, day to initiation and goal feeding, caloric intake, weekly biomarkers (pre-albumin, albumin, C-reactive protein), and end organ recovery (metabolic, hepatic, renal, pulmonary) scores were compared between the 2 groups. Results: The were 45 consecutive patients that underwent ECMO during the study period; 16 patients survived and 29 did not survive. Age, sex, preoperative co-morbidity, type and duration of ECMO were similar between the 2 groups. Survivors had better preoperative SOFA scores (average of 11 in survivors vs 13 in non-survivors, p=0.01), preoperative SAPS scores (52 vs 62, p=0.01), and preoperative creatinine values (1.2 mg/dl vs 1.8 mg/dl, p=0.03). All patients that survived were started on tube feeds within 2 days of ECMO initiation in contrast to 59% of non-survivors (p= 0.004). 88% of survivors versus 59% of non-survivors met adequate caloric feeding goals by day 3 (p=0.04). TPN was more frequently utilized in survivors in addition to tube feeds (50% vs 14%, p=0.009). Pre-albumin values were similar between the 2 groups during the first 3 weeks, however were better in survivors by week 4 from ECMO initiation (20 mg/dl vs 14 mg/dl, p=0.001). Conclusions: We found that the patients who were started on feeds earlier and the patients who met calorie goals in the earlier stages after initiation of ECMO had lower mortality, although other factors may contribute to survival as well.