ECLS: Nourish to Survive?

Objectives: Critical ill patients on ECLS or ECMO exhibit a poor prognosis. Nutrition is essential during ICU and determines outcome. Nonetheless, defined data on nutrition of ECLS patients and relevance of enteral and parenteral regimes on outcome and technical integrity are lacking.

Methods: ECLS and ECMO were investigated for enteral, parenteral nutrition, citrate substitution, and medical delivery of nutritional equivalents in Ebb-, catabolic- and anabolic-flow phase. Weaning from support, discharge, 30-day survival and 1-year survival, ICU morbidity and patient recovery, and technical integrity of oxygenators were studied.

Results: We treated 248 patients with veno-arterial ECLS (acute cardiac failure 71%) and veno-venous ECMO (pulmonary decompensation 29%). 64% were male. Mean age was 56.7 years (18–87). Weaning from ECLS/ECMO was successful in 55%. 30-day/1-year survival was 34%/21% (62% after discharge/year). Early mortality (10% sepsis/50% multiorgan failure) and late mortality (26% cardiac/7% pulmonary) differed. Mean BMI was 28.24 kg/m² with 28% BMI < 26 kg/m², 40%; 26 > BMI < 30 kg/m², 32%; BMI > 30 kg/m². In survivors (SV) and nonsurvivors (NS), nutrition differed. Caloric intake was 72% calculated goal/actual body weight. SV reached 74% vs. 61% in NS (p < 0.05). SV obtained earlier enteral (e) nutrition and earlier combination (c) with parenteral (p) substitution compared to NS (61% CCI) (e/p/c; Ebb 67/7/26% vs. 59/10/31%; CF 56/5/39% vs 55/5/39%; AF 46/13/41% vs. 51/9/40%; p < 0.05). Effects were stronger for 1 year survival (e/p/c; S vs. NS; Ebb 70/4/26% vs. 58/10/32%; CF 60/6/34% vs. 53/4/42%; AF 57/14/29% vs. 45/11/44%; p < 0.05). Nutrition scaled up (Ebb to AF) but increase and magnitude was higher in SV (kcal/h; Ebb/CF/AF; 75/79/105 vs. 74/75/92; p < 0.05). Nine oxygenators were changed once, 1 system twice (thrombus), 2 oxygenators had gas exchange dysfunction, yet dysfunction did neither correlate to nutrition nor anticoagulation. Blood gas analysis / CO₂-pressure are unusable for caloric calculation as governed by ECMO/ECLS. Citrate administration and medical lipid-calories did not further bias patient outcome or technical dysfunction.

Conclusions: Patients undergoing ECLS and ECMO treatment are critically ill and exhibit high mortality during intensive care treatment and after discharge. Phase adopted, calculated and stringent nutrition improves ECLS survival.

No conflict of interest has been declared by the author(s).