Medical Nutrition Therapy in Patients Receiving Extracorporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is a therapeutic option for management the patients with acute cardiac and/or respiratory failure. This technique is used to recovery or to bridge patients to a destination therapy. In general, these patients show a hypermetabolic state with high protein catabolism and concomitant use of vasoactive agents, steroids, and long-term sedation. This may impair gastrointestinal functions, compounding the risk for malnutrition. We suggest considering approaches to ensure adequate medical nutrition therapy for all ECMO patients. Guidance for nutrition risk screening and assessment should be performed in all patients. For patients requiring ECMO, energy, protein, and fluid goals should be determined. Enteral nutrition is the preferred route and early initiation should be considered. However, if the patients’ gut does not work properly, parenteral nutrition is recommended. Nonetheless, specific concern should be given to intravenous lipid emulsion as it may damage the ECMO circuit. Monitoring gas exchange via an oxygenator is recommended during administration intravenous lipid emulsion daily. The unstable hemodynamic status commonly found in patients with VA ECMO may reduce the perfusion of the gut. This may lead to an increased risk of feeding intolerance and intestinal ischemia. Therefore, enteral feedings should be given with special concern. In contrast, VV ECMO is mostly used in patients with severe respiratory failure so feeding intolerance is generally less common. Monitoring of this nutritional therapy is suggested to ensure adequate individual energy and nutrient intake on a routine basis.