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

INTRODUCTION: Patients on extracorporeal membrane oxygenation (ECMO) are among the most severe in the intensive care unit (ICU), they require complex treatment, accompanied by a long stay in the hospital and rehabilitation. Nutritional support (NS) plays an important role in the intensive care program. Despite an increase in the use of ECMO in the ICU over the past decade, informative clinical data regarding the optimal methods of maintaining nutritional status and controlling metabolism are rare. The lack of evidence base and guidelines for NS for adult patients on ECMO results in heterogeneity in clinical practice regarding optimal macro and micronutrient requirements, time of NS initiation, type and amount of nutritional support solutions. OBJECTIVE: Provide a review and critical assessment of the latest data regarding NS in critically ill adult patients on ECMO. MATERIALS AND METHODS: A systematic search and selection of publications was performed using the PubMed database. Studies published from 2012 to 2021 were analyzed to explore the approaches to NS in ECMO patients. Relevant studies were limited to randomized controlled trials, observational studies and clinical trials. RESULTS: A total of 14 observational studies were selected. Early enteral nutrition has been considered safe and feasible for ECMO patients, but achieving energy and protein targets is challenging. Data on the impact of NS on clinical outcomes and complications have been conflicting. Efforts should be made to achieve an adequate patient supply on ECMO of more than 80 % of the calculated energy and protein targets. NS in ECMO patients should be carried out in accordance with current guidelines for NS in critically ill patients until further data become available. CONCLUSIONS: A personalized approach is important principle of nutritional and metabolic therapy. Further studies are needed to investigate the association of various NS methods on clinical outcome endpoints in ICU ECMO patients.