Outcomes associated with delayed enteral feeding after cardiac arrest treated with veno-arterial extracorporeal membrane oxygenation and targeted temperature management

Abstract

Introduction: While early enteral nutrition is generally preferred in critically ill patients, the optimal timing of feeding among refractory cardiac arrest patients is unknown. We examined the association between timing of enteral nutrition and patient survival and safety outcomes in patients with refractory out-of-hospital cardiac arrest (OHCA) who were treated with extracorporeal cardiopulmonary resuscitation (ECPR).Methods: We performed a retrospective analysis of 142 consecutive patients presenting with OHCA due to ventricular fibrillation or ventricular tachycardia treated with ECPR and targeted temperature management (TTM). Neurologically favorable survival and clinical outcomes were compared between patients who received early enteral nutrition (<48 h after admission to the intensive care unit) and patients receiving delayed enteral nutrition (initiated >48 h after admission).Results: Enteral nutrition was initiated in 90/142 (63%) patients. Early enteral nutrition was provided in 34/90 (38%) while delayed nutrition occurred in 56/90 (62%). In adjusted analysis including patients who received nutrition, delayed enteral feeding was associated with increased odds of neurologically favorable survival (29 vs 54%, CI 1.04À7.25, p = 0.04). There were no significant differences in the incidence of pneumonia (18 vs 27%, p = 0.16), gastrointestinal bleeding (5.9 vs 3.6%, p = 0.42), intestinal ischemia (5.9 vs 5.4%, p = 0.90), ileus (12 vs 11%, p = 0.98), or need for tracheostomy (15 vs 20%, p = 0.81) between early and late feeding groups. Conclusion:In patients with refractory OHCA treated with ECPR and TTM, delayed enteral nutrition was associated with improved neurologically favorable survival. Adverse events related to enteral feeding were not associated with timing of feeding initiation.

Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis

“…They also found that adverse events related to enteral nutrition were not correlated with the timing of feeding initiation. However, the study involved obese patients with an average BMI ≥30 kg/m 2 , and the results may differ from those of patients with a normal BMI [ 25 ]. Martin et al [ 24 ] reported a low incidence of respiratory complications and mortality rate despite prolonged morbidity and hospitalization after early enteral nutrition in patients with an average BMI of 28.5 kg/m 2 .…”

Protein-energy metabolism and nutritional support in patients on extracorporeal membrane oxygenation: a systematic review

“…Затем были исключены обзоры, клинические случаи, исследования в детской когорте, рецензии на проведенные исследования. После оценки полнотекстовых ста тей и применения критериев включения отобрано 15 исследований [31,[38][39][40][41][42][43][44][45][46][47][48][49][50][51], среди которых 8 ретроспективных и 6 проспективных обсервационных, 1 эксперимент ex vivo. Алгоритм отбора представлен на рис.…”

“…В 11 исследованиях (8 ретроспективных и 3 проспективных) описывается практика НП и ее взаимосвязь с клиническими исходами [38][39][40][41][42][43][44][45][46][47][48]. В 3 проспективных исследованиях оцениваются индивидуальные потребности в энергии и белке, которые сравниваются со стандартизированными значениями энергопотребления.…”

“…Нами было найдено 10 обсервационных исследований, в которых сообщалось о сроках начала НП у пациентов на ЭКМО [38][39][40][42][43][44][45][46][47][48]. В одном исследовании [39] ПП назначалось с 1-го дня, а ЭП начиналось со 2-го дня.…”

“…В остальных случаях ЭП было первой линией НП. При этом раннее ЭП (в первые 24-48 ч) назначалось в 8 исследованиях [38,39,42,[44][45][46][47][48], если не было противопоказаний, а в трех из них медиана времени начала НП составила около 13 ч [42,44,46].…”