Early enteral nutrition and factors related to in-hospital mortality in people on extracorporeal membrane oxygenation

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Vol. 89; p. 111222
• Main Authors: Kim, Sua, Jeong, Su Kang, Hwang, Jinwook, Kim, Je Hyeong, Shin, Jae Seng, Shin, Hong Ju
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2021; Elsevier Limited
• Subjects: Acute coronary syndromes; Adequacy; Adequate nutritional support; Confidence intervals; Early enteral nutrition; ECMO; Energy; Energy intake; Enteral nutrition; Extracorporeal membrane oxygenation; Length of stay; Medical prognosis; Membranes; Mortality; Nutrition; Oxygenation; Parenteral nutrition; Patients; Proteins; Regression analysis; Survival; ECMO; Parenteral nutrition; Adequate nutritional support; Early enteral nutrition; Mortality
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2021.111222

•Early enteral nutrition (EN) was related to decreased in-hospital mortality.•Adequate energy support was not related to decreased in-hospital mortality.•The contribution of EN versus parenteral nutrition was not related to in-hospital mortality.•EN can be recommended in the early stages of extracorporeal membrane oxygenation even when the energy intake from EN is small.
There are concerns about adverse events related to early enteral nutrition (EN) in people receiving extracorporeal membrane oxygenation (ECMO). This was a retrospective study evaluating. This nutritional support of people receiving ECMO, factors that may confer benefits in outcomes.
60 adults on ECMO who survived for more than 48 h were enrolled in the study. We evaluated energy and protein intake and the associations of the timing, adequacy, and route of nutrition with in-hospital mortality.
Thirty-three participants (55%) were successfully weaned off ECMO, and 30 (50%) survived. EN was initiated on day 2 of ECMO (interquartile range, 1–3), and the mean energy intake on day 7 of ECMO was 94.1% ± 41.8% of the energy requirement. Although early EN significantly decreased in-hospital mortality (hazard ratio, 0.413; 95% confidence interval, 0.174–0.984; P = 0.046), neither adequate energy intake (hazard ratio, 0.982; 95% confidence interval, 0.292–3.301; P = 0.977) nor EN-dominant nutritional support (hazard ratio, 0.394; 95% confidence interval, 0.138–1.128; P = 0.083) in the first week influenced survival.
Although adequate nutritional support and EN-dominant nutritional support were not associated with changes in outcome, early EN was associated with reduced in-hospital mortality. Therefore, even when EN is not the dominant route of nutritional support, early EN may be recommended for better outcomes in people on ECMO.