Influence of the ECMO circuit on the concentration of nutritional supplements

Abstract

Circulating compounds such as drugs and nutritional components might adhere to the oxygenator fibers and tubing during ECMO support. This study evaluated the amount of nutritional supplements adsorbed to the ECMO circuit under controlled ex vivo conditions. Six identical ECMO circuits were primed with fresh human whole blood and maintained under physiological conditions at 36 °C for 24 h. A dose of nutritional supplement calculated for a 70 kg patient was added. 150 mL volume was drawn from the priming bag for control samples and kept under similar conditions. Blood samples were obtained at predetermined time points and analyzed for concentrations of vitamins, minerals, lipids, and proteins. Data were analyzed using mixed models with robust standard errors. No significant differences were found between the ECMO circuits and the controls for any of the measured variables: cobalamin, folate, vitamin A, glucose, minerals, HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides or total proteins. There was an initial decrease and then an increase in the concentration of cobalamin and folate. Vitamin A concentrations decreased in both groups over time. There was a decrease in concentration of glucose and an increased concentration of lactate dehydrogenase over time in both groups. There were no significant alterations in the concentrations of nutritional supplements in an ex vivo ECMO circuit compared to control samples. The time span of this study was limited, thus, clinical studies over a longer period of time are needed.

Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

“…A previous ex vivo ECMO model demonstrated circuit losses of essential amino acid isoleucine, vitamin A, and vitamin E via postulated mechanisms of instability, degradation, circuit sequestration, or oxidation in the ECMO circuit ( 36 ). Vitamin A, in particular, is light-sensitive and prone to photolysis even in fat emulsion and light-protected bags ( 37 ). A single-center retrospective study of 78 pediatric patients on ECMO found that calcium derangements occur frequently and are associated with increased ECMO duration, length of ICU stay, and hospital stay ( 38 ).…”

Medical nutrition therapy in patients receiving ECMO: Evidence‐based guidance for clinical practice

“…In this context, Estensen et al 68 performed an ex vivo single‐dose circuit study and observed significant loss of the amino acids alanine (10%), arginine (95%), cysteine (14%), glutamine (25%), and isoleucine (7%), and the fat‐soluble vitamins A (42%) and E (6%). There were significant increases in other amino acids, zinc, vitamin C, and no alterations in the concentrations of selenium, copper, manganese, or vitamin D. On the contrary, Lindberg et al 73 found no significant alterations in the concentrations of nutrients in an ex vivo ECMO circuit, as compared with control samples.…”

The NIH Lipo-COVID Study: A pilot NMR investigation of lipoprotein subfractions and other metabolites in patients with severe COVID-19.

“…Finally, another potentially important finding of this study was detecting the presence of LpX and LpZ particles in plasma of patients with severe COVID-19, indicating the need for further investigating the potential value of these abnormal lipoprotein profiles as prognostic and/or risk-stratification markers in patients with COVID-19. Nonetheless, the clinical implications of this study remain currently limited, due to its small sample size, its retrospective nature, the limited outcome data available for the included patients, and the unknown potential effects of ECMO on various plasma metabolites, including lipoproteins [57]. Moreover, most patients in our cohort had obesity (BMI ≥ 30), which itself affects lipoproteins, and therefore constitutes a confounder.…”