Nutritional support in adult patients receiving extracorporeal membrane oxygenation

Patients receiving extracorporeal membrane oxygenation (ECMO) are some of the most critically ill in the intensive care unit. In such patients, malnutrition is associated with increased morbidity and mortality.

To describe the use, methods and adequacy of nutritional support in a consecutive group of patients receiving ECMO; to determine differences between the periods during and after ECMO support; and to determine differences in nutritional adequacy between ECMO survivors and ECMO non-survivors.

We conducted a retrospective study of patients who received ECMO at the Alfred Hospital between January 2005 and December 2007. Patients who received venoarterial (VA) or venovenous (VV) ECMO had their case notes reviewed for clinical and nutritional outcomes. Nutritional adequacy was defined as the ratio of delivered nutrition to target nutrition, expressed as a percentage.

Of 48 patients included in our analysis, 35 had VA ECMO and 13 had VV ECMO. Overall, the mean nutritional adequacy achieved for all patients over the periods during and after ECMO support was 62% (SD, 19%). Nutritional adequacy was lower during ECMO support (55%) than after ECMO removal (71%) (P = 0.003). Survivors did not achieve better nutritional adequacy than non-survivors (52% v 61%; P = 0.345).

Patients receiving ECMO received inadequate nutritional support, with only 55% of their nutritional targets being achieved while receiving ECMO. Optimal nutritional support should be a major goal in the care of these patients, and measures to improve nutritional delivery require careful consideration.