Nutritional Support in Postcardiotomy Shock Extracorporeal Membrane Oxygenation Patients: A Prospective, Observational Study

Megan F. Hunt, Alejandro Suarez Pierre, Xun Zhou, Cecillia Lui, Brian D. Lo, Patricia M. Brown, Glenn Whitman, Chun Woo Choi

Research output: Contribution to journalArticle

Abstract

Background: Despite the 6000 patients treated with extracorporeal membrane oxygenation (ECMO) annually, there is a paucity of data regarding the nutritional management of these patients. Materials and methods: We performed a prospective, observational study of nutrition in postcardiotomy shock patients at our institution. Over a 3.5-year study period, we identified 50 ECMO patients and 225 non-ECMO patients. We identified type, amount, duration, and disruption of nutritional delivery by cohort. The primary outcome was percent of caloric goal met, and secondary outcome was gastrointestinal complications. Results: ECMO patients met less of their caloric (29% versus 40%, P = 0.017) and protein goals (34% versus 55%, P < 0.001) compared with non-ECMO patients. Tube feeds were administered more slowly (26 versus 37 mL/h, P < 0.001) and held for longer (8.3 versus 4.5 h/d, P < 0.001) in ECMO patients because of procedures (60%) and high-dose pressors (20% versus 7%, P < 0.001). Multivariate analysis demonstrated that ECMO decreased caloric intake by 14%, with no detected increased risk of gastrointestinal complications. Conclusions: –ECMO patients received significantly less nutrition support compared with a non-ECMO population. Tube feed hold deficits could potentially be avoided by utilizing postpyloric tubes to feed through procedures, by eliminating holds for vasopressors/inotropes in hemodynamically stable patients, or by establishing volume-based feeding protocols. Further clinical studies are needed to establish efficacy of these interventions and to understand the impact of nutrition on outcomes in ECMO patients.

Original languageEnglish (US)
Pages (from-to)257-264
Number of pages8
JournalJournal of Surgical Research
Volume244
DOIs
StatePublished - Dec 1 2019

Fingerprint

Extracorporeal Membrane Oxygenation
Nutritional Support
Observational Studies
Shock
Prospective Studies
Membranes
Energy Intake
Multivariate Analysis

Keywords

  • Critical care
  • ECMO
  • Enteral nutrition
  • Postcardiotomy shock
  • VIS score

ASJC Scopus subject areas

  • Surgery

Cite this

Nutritional Support in Postcardiotomy Shock Extracorporeal Membrane Oxygenation Patients : A Prospective, Observational Study. / Hunt, Megan F.; Pierre, Alejandro Suarez; Zhou, Xun; Lui, Cecillia; Lo, Brian D.; Brown, Patricia M.; Whitman, Glenn; Choi, Chun Woo.

In: Journal of Surgical Research, Vol. 244, 01.12.2019, p. 257-264.

Research output: Contribution to journalArticle

Hunt, Megan F. ; Pierre, Alejandro Suarez ; Zhou, Xun ; Lui, Cecillia ; Lo, Brian D. ; Brown, Patricia M. ; Whitman, Glenn ; Choi, Chun Woo. / Nutritional Support in Postcardiotomy Shock Extracorporeal Membrane Oxygenation Patients : A Prospective, Observational Study. In: Journal of Surgical Research. 2019 ; Vol. 244. pp. 257-264.
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abstract = "Background: Despite the 6000 patients treated with extracorporeal membrane oxygenation (ECMO) annually, there is a paucity of data regarding the nutritional management of these patients. Materials and methods: We performed a prospective, observational study of nutrition in postcardiotomy shock patients at our institution. Over a 3.5-year study period, we identified 50 ECMO patients and 225 non-ECMO patients. We identified type, amount, duration, and disruption of nutritional delivery by cohort. The primary outcome was percent of caloric goal met, and secondary outcome was gastrointestinal complications. Results: ECMO patients met less of their caloric (29{\%} versus 40{\%}, P = 0.017) and protein goals (34{\%} versus 55{\%}, P < 0.001) compared with non-ECMO patients. Tube feeds were administered more slowly (26 versus 37 mL/h, P < 0.001) and held for longer (8.3 versus 4.5 h/d, P < 0.001) in ECMO patients because of procedures (60{\%}) and high-dose pressors (20{\%} versus 7{\%}, P < 0.001). Multivariate analysis demonstrated that ECMO decreased caloric intake by 14{\%}, with no detected increased risk of gastrointestinal complications. Conclusions: –ECMO patients received significantly less nutrition support compared with a non-ECMO population. Tube feed hold deficits could potentially be avoided by utilizing postpyloric tubes to feed through procedures, by eliminating holds for vasopressors/inotropes in hemodynamically stable patients, or by establishing volume-based feeding protocols. Further clinical studies are needed to establish efficacy of these interventions and to understand the impact of nutrition on outcomes in ECMO patients.",
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T2 - A Prospective, Observational Study

AU - Hunt, Megan F.

AU - Pierre, Alejandro Suarez

AU - Zhou, Xun

AU - Lui, Cecillia

AU - Lo, Brian D.

AU - Brown, Patricia M.

AU - Whitman, Glenn

AU - Choi, Chun Woo

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N2 - Background: Despite the 6000 patients treated with extracorporeal membrane oxygenation (ECMO) annually, there is a paucity of data regarding the nutritional management of these patients. Materials and methods: We performed a prospective, observational study of nutrition in postcardiotomy shock patients at our institution. Over a 3.5-year study period, we identified 50 ECMO patients and 225 non-ECMO patients. We identified type, amount, duration, and disruption of nutritional delivery by cohort. The primary outcome was percent of caloric goal met, and secondary outcome was gastrointestinal complications. Results: ECMO patients met less of their caloric (29% versus 40%, P = 0.017) and protein goals (34% versus 55%, P < 0.001) compared with non-ECMO patients. Tube feeds were administered more slowly (26 versus 37 mL/h, P < 0.001) and held for longer (8.3 versus 4.5 h/d, P < 0.001) in ECMO patients because of procedures (60%) and high-dose pressors (20% versus 7%, P < 0.001). Multivariate analysis demonstrated that ECMO decreased caloric intake by 14%, with no detected increased risk of gastrointestinal complications. Conclusions: –ECMO patients received significantly less nutrition support compared with a non-ECMO population. Tube feed hold deficits could potentially be avoided by utilizing postpyloric tubes to feed through procedures, by eliminating holds for vasopressors/inotropes in hemodynamically stable patients, or by establishing volume-based feeding protocols. Further clinical studies are needed to establish efficacy of these interventions and to understand the impact of nutrition on outcomes in ECMO patients.

AB - Background: Despite the 6000 patients treated with extracorporeal membrane oxygenation (ECMO) annually, there is a paucity of data regarding the nutritional management of these patients. Materials and methods: We performed a prospective, observational study of nutrition in postcardiotomy shock patients at our institution. Over a 3.5-year study period, we identified 50 ECMO patients and 225 non-ECMO patients. We identified type, amount, duration, and disruption of nutritional delivery by cohort. The primary outcome was percent of caloric goal met, and secondary outcome was gastrointestinal complications. Results: ECMO patients met less of their caloric (29% versus 40%, P = 0.017) and protein goals (34% versus 55%, P < 0.001) compared with non-ECMO patients. Tube feeds were administered more slowly (26 versus 37 mL/h, P < 0.001) and held for longer (8.3 versus 4.5 h/d, P < 0.001) in ECMO patients because of procedures (60%) and high-dose pressors (20% versus 7%, P < 0.001). Multivariate analysis demonstrated that ECMO decreased caloric intake by 14%, with no detected increased risk of gastrointestinal complications. Conclusions: –ECMO patients received significantly less nutrition support compared with a non-ECMO population. Tube feed hold deficits could potentially be avoided by utilizing postpyloric tubes to feed through procedures, by eliminating holds for vasopressors/inotropes in hemodynamically stable patients, or by establishing volume-based feeding protocols. Further clinical studies are needed to establish efficacy of these interventions and to understand the impact of nutrition on outcomes in ECMO patients.

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KW - ECMO

KW - Enteral nutrition

KW - Postcardiotomy shock

KW - VIS score

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