Early Enteral Nutrition Does Not Cause Excessive Inflammatory Response in Veno-Arterial Extracorporeal Membrane Oxygenation Patients

Abstract

Background: To evaluate the safety between early enteral nutrition (EN) and parenteral nutrition (PN) by observing changes in inflammatory cytokines and gastrointestinal hormones in veno-arterial extracorporeal membrane oxygenation (VA ECMO) patients. Methods: This study was a prospective, observational study that enrolled patients receiving VA ECMO treatment from 1 January 2020 to 31 December 2023. Patients were enrolled in an EN group or a PN group according to the inclusion criteria. The concentration of interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor α (TNF-α) on the first five days of VA ECMO treatement were tested in both groups. Serum concentrations of Motilin (MOT), Gastrin (GAS), Cholecystokinin (CCK), and Calcitonin gene-related peptide (CGRP) were measured for the EN group. Student t test or Fisher test was used to compare the difference between the two groups. Results: 28 patients were enrolled in this study; 16 in the EN group and 12 in the PN group. The baseline characteristics were comparable between the two groups. The concentration of IL-1β in the EN group was significantly lower than that of the PN group on day 3 and day 4 (day 3: 0.65 ± 0.17 pg/mL vs. 0.93 ± 0.09 pg/mL, p < 0.01, day 4: 0.52 ± 0.16 pg/mL vs. 0.74 ± 0.12 pg/mL, p < 0.01). The concentration of IL-6 and TNF-α in the EN group were also significantly lower than in the PN group on day 3 and day 4. There was no statistical difference in IL-10 serum concentration between the EN group and the PN group from day 1 to day 5. On day 3, the concentration of MOT, GAS and CCK reached the highest level and then gradually decreased. Conclusions: Implementation of early EN in patients receiving VA ECMO does not cause significant elevation of pro-inflammatory cytokines with an excessive inflammatory response.