Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

Abstract

Extracorporeal membrane oxygenation (ECMO) support is increasingly utilized in quaternary pediatric intensive care units. Metabolic derangements and altered nutritional requirements are common in critically ill children supported on ECMO. However, there remains no consensus on the optimal approach to the prescription of nutrition in these patients. This narrative review aims to summarize the current medical literature on various aspects of nutrition support in pediatric patients on ECMO. These include: (1) nutritional adequacy, (2) pros and cons of feeding on ECMO, (3) enteral vs. parenteral nutrition, and (4) proposed recommendations and future directions for research in this area.

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

“…Overall, volume‐based feeding may be advantageous in hemodynamically stable patients not at risk for refeeding syndrome, enteral feeding intolerance, or other complications 108 . In addition, protocols within the ICU are useful, have been shown to reduce time to reach energy targets and to decrease feeding intolerances, and are associated with improved patient outcome 109,110 . Therefore, implementation of nutrition protocols should be considered in patients receiving ECMO.…”

“…108 In addition, protocols within the ICU are useful, have been shown to reduce time to reach energy targets and to decrease feeding intolerances, and are associated with improved patient outcome. 109,110 Therefore, implementation of nutrition protocols should be considered in patients receiving ECMO.…”

Care Management for Patients with Covid-19 Receiving Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review

“…The enteral nutrition (EN) is important to regulates gastrointestinal motility, in addition is generally well tolerated by most patients; serious adverse events is not reported, such as intestinal ischemia, gastrointestinal bleeding or other complications. Enteral nutrition intolerance is common in clinical practice, and can be demonstrated by residual gastric volume (> 500 ml), vomiting and abdominal distension, in these cases, total parenteral nutrition (TPN) is considered (Rocha et al, 2020;Toh et al, 2021).…”

Association between enteral feeding and gastrointestinal complications in children receiving extracorporeal life support: A retrospective cohort study

“…1,2 However, children receiving extracorporeal life support (ECLS) are at higher risk for complications, owing to impaired circulation and/or hypoxemia prior to ECLS support. 3 Critically ill children who require ECLS generally have some degree of impaired systematic perfusion and/or hypoxemia, which reduces gut perfusion, thus increasing the risk of ischemic gut/bowel and necrotizing enterocolitis (NEC). 3 Enteral feeding increases metabolic demands and may exacerbate the mismatching of perfusion.…”

“…3 Critically ill children who require ECLS generally have some degree of impaired systematic perfusion and/or hypoxemia, which reduces gut perfusion, thus increasing the risk of ischemic gut/bowel and necrotizing enterocolitis (NEC). 3 Enteral feeding increases metabolic demands and may exacerbate the mismatching of perfusion. 4 Other interventions associated with ECLS, such as high doses of opiates, sedatives, and catecholamines, may cause delayed gastric emptying, contributing to feed intolerance.…”