Abstract
Circulating compounds such as drugs and nutritional components might adhere to the oxygenator fibers and tubing during ECMO support. This study evaluated the amount of nutritional supplements adsorbed to the ECMO circuit under controlled ex vivo conditions. Six identical ECMO circuits were primed with fresh human whole blood and maintained under physiological conditions at 36 °C for 24 h. A dose of nutritional supplement calculated for a 70 kg patient was added. 150 mL volume was drawn from the priming bag for control samples and kept under similar conditions. Blood samples were obtained at predetermined time points and analyzed for concentrations of vitamins, minerals, lipids, and proteins. Data were analyzed using mixed models with robust standard errors. No significant differences were found between the ECMO circuits and the controls for any of the measured variables: cobalamin, folate, vitamin A, glucose, minerals, HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides or total proteins. There was an initial decrease and then an increase in the concentration of cobalamin and folate. Vitamin A concentrations decreased in both groups over time. There was a decrease in concentration of glucose and an increased concentration of lactate dehydrogenase over time in both groups. There were no significant alterations in the concentrations of nutritional supplements in an ex vivo ECMO circuit compared to control samples. The time span of this study was limited, thus, clinical studies over a longer period of time are needed.
Highlights
Extracorporeal membrane oxygenation (ECMO) is used alongside conventional intensive care to support critically ill patients[1,2,3]
The ECMO circuit includes both polyvinyl chloride (PVC) tubing and oxygenator polymethylpentene (PMP) fibers which may bind a variety of circulating compounds such as drugs, and possibly nutrients, effectively reducing the bioavailability of these compounds
In our previous experience with ECMO circuits, we found a white layer deposited on the venous side of the oxygenator over time, we assumed this to consist of drugs or nutrients[9]
Summary
Extracorporeal membrane oxygenation (ECMO) is used alongside conventional intensive care to support critically ill patients[1,2,3]. It permits treatment and recovery during severe cardiac and pulmonary failure. Parenteral nutrition is commonly given as a sterile emulsion of water, protein, lipid, carbohydrate, electrolytes, vitamins, and trace elements. These nutrient groups have different sizes, charge, and binding properties. Any loss of vital nutrients due to adsorption to the ECMO circuits may lead to further nutritional debilitation in critical ill patients. This is important because there is growing evidence that malnutrition in critically ill patients influences morbidity and mortality[4,8]
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