Nutritional support and clinical outcomes in critically ill patients supported with veno-arterial extracorporeal membrane oxygenation

Summary Background and aims Patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are likely to be develop malnutrition because of catabolism and protein consumption. Administration of appropriate nutrition to these patients is difficult because of hemodynamic instability and multiorgan failure. The aim of this study was to evaluate the relationship between nutritional supply and clinical outcomes in patients undergoing VA-ECMO. Methods Patients who received VA-ECMO in a single tertiary teaching hospital between 2013 and 2018 were reviewed retrospectively. Linear regression and Cox regression were performed to assess the relationship between the following factors and clinical outcomes: sex, age, BMI, modified nutrition risk in the critically ill (mNUTRIC) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE II) score, ENCOURAGE score, daily average achievement of an energy target (%), and average protein intake during the first week and second week. Results Forty-one patients were included. Patients on VA-ECMO received lower amounts of energy and protein in the first week than in the second week (33.9 vs 77.7% target/day, 0.24 vs. 0.74 g/kg/day) and achieved 70% of their energy requirement at a median of 8 days after the initiation of VA-ECMO. Multiple Cox regression analysis revealed an association among energy received daily during the second week of VA-ECMO, mNUTRIC score, and 90-day mortality (hazard ratio, 0.82, 95% confidence interval [0.69–0.97], P=0.018 vs. hazard ratio, 1.51, 95% confidence interval [1.06–2.15], P=0.022). Conclusion In VA-ECMO patients, when the daily average energy intake increased by 10% of the target over 8–14 days, the 90-day mortality decreased by 18%.