Influence of Nutrition on the Short- and Long-Term Outcome after ECLS and ECMO Therapy

Objectives: Extracorporal live support and extracorporal membrane oxygenation in many cases exhibit a live-saving therapy. Nevertheless, morbidity and mortality rates remain high. Efforts are taken on hemodynamics, respiratory issues, and inflammation. Minor data are available on patient- or system-specific nutritional demand and risks regarding quantity and quality or time course–specific characteristics. We hypnotized that outcome over 30 days and 1 year in ECLS and ECMO patients and technical integrity are related to quantity, quality, and scheduling of nutritional equivalents.

Methods: ECLS/ECMO patients were retrospectively analyzed in a multiprofessional setup of pneumology, cardiology, and cardiac surgery intensive care units of two centers. Indication for extracorporal support was urgent or emergent. We analyzed nutrition regarding quality, substrates, medication, and overall quantity in Ebb, catabolic, and anabolic flow phase. We evaluated for effects on perioperative morbidity, short-term and long-term survival, and technical integrity of support systems.

Results: A total of 247 patients were treated (71.3% ECLS, acute cardiac failure/28.7% ECMO, pulmonary decompensation); 63.6% were male. ECMO patients were younger; mean age was 56.6 years (18–87). Thirty-day/1-year survival was higher in ECMO vs. ECLS (28.7/22.9 vs. 51.4/32%) but overall good after discharge (85.5%/year). Early mortality (10% sepsis/50% multiorgan failure) and late mortality (26% cardiac/7% pulmonary) differed. Mean BMI was 28.2 kg/m². Dying patients were more likely obese and exhibited higher BMI. Nutrition differed between survivors (SV) and nonsurvivors (NS). Calculated caloric intake (CCI) was 72% of actual body weight (SV: 74% vs. NS: 61%; p < 0.05). Thirty-day survivors obtained earlier enteral nutrition and earlier combination with parenteral substitution compared to NS. Effects were even stronger for 1-year survival. Nutrition increased stronger from Ebb to anabolic flow in survivors. We changed nine oxygenators once, one system twice (thrombus), and two oxygenators had gas exchange dysfunction, without relation to nutrition. Peripheral citrate administration and lipophilic medication did not bias patient outcome or technical dysfunction.

Conclusion: ECLS/ECMO patients exhibit high mortality during intensive care treatment but good survival after discharge. Phase adopted, calculated, and stringent nutrition improves short- and long-term survival without affecting oxygenator integrity.