536 - Nutrition Support Practices in Pediatric Veno-Venous (VV) vs Veno-Arterial (VA) Extracorporeal Membrane Oxygenation (ECMO): A Retrospective Analysis

Publication Number: 1515.536

Jesse Stoakes, Baylor College of Medicine, Houston, TX, United States; Nancy Chung, University of Texas Southwestern Medical School, Dallas, TX, United States; Sarah Nelin, University of Mississippi School of Medicine, Jackson, MS, United States; Kelly F. Martinek, Baylor College of Medicine, Houston, TX, United States; Nicole Knebusch, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, United States; Blessy Philip, Texas Children's Hospital, Missouri, TX, United States; Andrea Ontaneda, Baylor College of Medicine, Houston, TX, United States; Jorge Coss-Bu, Baylor College of Medicine, Houston, TX, United States; Marwa Mansour, Baylor College of Medicine, Houston, TX, United States

Background: Despite the recognized importance of nutrition in critically ill children, there remain several unanswered questions regarding the optimal approach to nutritional support in pediatric ECMO patients, including appropriate initiation timing, route, enteral (EN) vs. parenteral (PN), target caloric and protein delivery, and mitigating feeding intolerance.

Objective: This study explores the nutrition delivery practices for patients on ECMO during the first week of cannulation.

Design/Methods: Retrospective cohort study of children admitted to the PICU and placed on VA or VV ECMO from 2015 to 2024. Inclusion criteria included 1) >7 days of ECMO 2) calculable nutrition intake. Patients post cardiac surgery were excluded. BMR was calculated by Schofield equation. Protein intake was determined per ASPEN 2009. Nutrition adequacy was (intake/recommended) × 100. Goal was 60%. Analysis by Chi-Square and Mann-Whitney.

Results: 115 patients were enrolled (51% female) with median age at cannulation of 3 (1-11.75) yrs, weight 14.7 (8.9-38.8) kg, VA ECMO 20%, VV ECMO 69%, ECMO LOS 398 (216-728) hrs, and ICU LOS 46 (26-75.8) days. 53% of patients were seen by a dietitian within 48 hours of cannulation.
On Day 1, 2% of patients met calorie and protein goal adequacy via EN. From EN+ PN, 18% and 2% met calorie and protein adequacy, respectively on day 1. By day 7, 30% and 29% of patients met calorie and protein adequacy, respectively, from EN. Simultaneously, 83% and 78% calorie and protein adequacy, respectively, from EN+PN.
Patients on VV ECMO achieved higher EN protein and caloric adequacy than those on VA ECMO by day 3 (p < 0.05). Patients who were on enteral diet within 48 hrs before ECMO were more likely to be on enteral diet on day 1, 47.5% vs 16.7%; p < 0.0005.

Conclusion(s): Patients on ECMO were unable to meet calorie and protein needs within the first week of cannulation from enteral nutrition alone. Although VV ECMO patients received higher EN, the majority of patients needed EN+PN to achieve goal adequacy by day 7. There were no observed complications from advancing EN in this cohort. Prospective multicenter studies are needed to improve nutrition optimization in patients on ECMO.

Table 1. Patient Demographics for Nutrition Support


Table 2. Protein and caloric adequacy in VA vs VV patients from EN


Table 3. Protein and caloric adequacy in VA vs VV patients from EN + PN