Vasopressors and Enteral Nutrition in the Survival Rate of Children During Extracorporeal Membrane Oxygenation

Abstract

Objectives: Nutrition support is essential in improving outcome and survival in children on extra corporal membranous support (ECMO). We aim to evaluate the association between the timing of enteral nutrition (EN) initiation and its impact on outcome. Methods: We retrospectively reviewed the electronic health records of children (≤18 years) from November 2014 to November 2019 who were on veno-arterial ECMO for ≥48 hours. Abstracted data included demographics, ECMO indication and duration, timing of EN initiation, change in weight-for-age z score (WAZ), and survival rate. The vasoactive-inotropic score (VIS) was calculated to assess illness acuity. Results: We identified 76 children with median age (interquartile range [IQR]) of 0.3 years (0-2.6), 46 of which were infants (59%) who required ECMO for a median (IQR) of 10 days (6-22). Thirty-six (47%) survived to hospital discharge. EN was initiated in 55 (72%) of patients while on ECMO. EN initiation by day 3 of ECMO was positively associated with survival (P = 0.0438). VIS at the time of EN initiation was lower in surviving infants (P = 0.022). Children who achieved enteral autonomy were more likely to survive (P = 0.0024). Survivors had greater WAZs at ECMO completion (P = 0.0004). Conclusions: Initiation of EN by day 3 of ECMO and at a lower VIS is associated with greater likelihood of survival.

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

“…A further retrospective review of 51 children receiving ECLS in Singapore found a similar level of energy target achievement as our study, approximately 43% across the first 7 days of ECLS 16 . However, in their center, EN was initiated in only 64% of children.…”

“…After adjustment for key factors, they also found that greater EN energy achievement was associated with lower risk of mortality (adjusted odds ratio, 0.93 [95% confidence interval, 0.86-0.99]; P = 0.048). 14 This positive association with mortality reduction is also supported by Alexander et al 17 in a retrospective study of 76 children that examines the effect of EN timing on patient outcomes. They found that EN initiated by 72 h of ECLS was associated with improved survival (P = 0.043).…”

Enteral nutrition in children and adolescents who receive extracorporeal membrane oxygenation and its impact on complications and mortality: A systematic review and meta‐analysis

“…A total of nine studies initiated EN within 7 days of ECMO therapy. [11][12][13]17,18,21,22,24,27 One study had a median time to EN initiation of 23 h, 22 whereas four other studies started EN within 3 days. 12,17,18,21 In eight studies, the EN administration routes were gastric via oral or nasal tube, or postpyloric, 11,12,[18][19][20][23][24][25] but one study included children with gastrostomy.…”

“…[11][12][13]17,18,21,22,24,27 One study had a median time to EN initiation of 23 h, 22 whereas four other studies started EN within 3 days. 12,17,18,21 In eight studies, the EN administration routes were gastric via oral or nasal tube, or postpyloric, 11,12,[18][19][20][23][24][25] but one study included children with gastrostomy. 20 In terms of nutrition preparations, the majority of studies provided children with breast milk and various types of formula.…”

“…10 Several studies have evaluated the role of enteral feeding in children and adolescents who require ECMO therapy. [11][12][13] Alexander et al 11 evaluated 76 children who were treated with ECMO and found that EN initiation by day 3 was significantly associated with survival. Another retrospective single-center study of 100 children found that EN was initiated within 48 h after ECMO in 60.3% of patients and mortality was lower in patients who received EN.…”