Abstract
Introduction: Literature regarding the timing and safety of enteral feeding after cardiac arrest treated with therapeutic hypothermia and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is lacking. Aim: To describe the safety and feasibility of early enteral feeding in adult patients presenting with refractory out-of-hospital cardiac arrest treated with VA ECMO and therapeutic hypothermia. Methods: We performed a retrospective analysis of the enteral feeding patterns for patients admitted through the University of Minnesota ECPR program for refractory ventricular tachycardia or fibrillation (VT/VF). Outcomes were compared in patients with early enteral feeding initiation (within 2 days of admission) versus those with delayed enteral feeding (>2 days after admission). Results: The study included 108 consecutive patients (age 56.3+/-12.2 years, 78% male) admitted to the CICU between December 2015 and February 2019. Average CPR duration was 62.8+/-15.3min. Enteral feeding was initiated in 68(62.9%) of the sample. Enteral feeding was not started in patients expected to die within 48 hours of ICU admission. All patients underwent therapeutic hypothermia and 97.2% received neuromuscular blockade. Time to enteral feeding initiation ranged from 1 to 11 days post admission. Patients who had enteral feeding started within the first two days (43%) had similar rates of feeding interruption, (with 40% of cases in the setting of a surgical procedure or family request), gut ischemia, ileus and ventilator associated pneumonia (Table 1). Mortality and neurologic outcomes were not affected by timing of enteral feeding initiation. Conclusion: Initiation of enteral feeding within the first two days of presentation was not associated with adverse outcomes in patients with refractory cardiac arrest treated with prolonged CPR, VA ECMO, and therapeutic hypothermia.
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