Nutrition therapy in adult patients requiring Extracorporeal Membrane Oxygenation

This study was a multi-centre observational study which aimed to determine current feeding practices in patients receiving Extracorporeal Membrane Oxygenation (ECMO) in Australia and New Zealand. 

Goal: This study aimed to describe the current nutrition therapy practices and profile the barriers and enablers to successful feeding in patients requiring VV or VA ECMO whilst ECMO was in situ and for 7 days post ECMO removal.

Rationale: Extracorporeal membrane oxygenation (ECMO) is becoming an increasingly used and accepted mode of life support for adult patients with severe cardio-respiratory failure. ECMO can provide much needed time until organ transplantation, be a bridge to a ventricular assist device or provide support until the patient’s cardiac and/or respiratory function improves. More recently, ECMO has been a life-saving therapy employed during the swine flu pandemic and the landmark CESAR study has shown that ECMO improves outcomes in patients with the most severe lung injury. Nutrition therapy in the intensive care setting is an essential element of patient care. It has been clearly demonstrated to reduce complication rates and improve morbidity and mortality. Despite these reported benefits, clinicians continue to deliver little more than half of the enteral nutrition (EN) they plan to provide, partly due to patient intolerance and clinical interruptions. To date there is sparse data on nutrition in adult ECMO patients. Two previously published papers have shown that enteral nutrition is possible, however patients on ECMO receive significantly less nutrition, require prokinetics earlier than would have been expected and are slow to commence and progress nutrition. The reasons for this are not well-understood, however, there are several plausible explanations which we need to confirm to understand the consequences of inadequate nutrition therapy in this group and develop solutions.

Progress: Patient recruitment commenced in 2012 and completed in 2014. The results were published in 2015.

Funding: Funding was received from the Australian and New Zealand Society of Parenteral and Enteral Nutrition (AuSPEN).

Contact: For further information about this study, please contact the AuSPEN / ANZIC-RC ICU Nutrition Project Manager, Emma Ridley, by email.

Publication:

Ridley EJ, Davies AR, Robins EJ, Lukas G, Bailey MJ, Fraser JF. Nutrition therapy in adult patients receiving extracorporeal membrane oxygenation: A prospective, multicentre, observational study. Crit Care Resusc 2015;17:183-9.