Malnutrition in adult patients treated with venoarterial extracorporeal membrane oxygenation: A descriptive cohort study

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Abstract

Objective

To evaluate malnutrition and its association with outcomes in adult patients requiring venoarterial (VA) extracorporeal membrane oxygenation (ECMO).

Methods

Patients cannulated for VA ECMO between January 1, 2020, and January 1, 2023, were screened. Patients on ECMO for <48 hours or without a nutritional evaluation were excluded. Demographic and anthropometric data were collected retrospectively. Malnutrition assessments were conducted using the Global Leadership Initiative on Malnutrition framework. Outcomes analyzed were duration of ECMO and in-hospital mortality. Patients were stratified by admission and discharge nutritional status for analysis. Baseline characteristics were controlled for with propensity score matching.

Results

Data from 197 patients was analyzed. The cohort was 68% male. The median duration of ECMO was 139.5 hours (interquartile range [IQR], 94.8-257 hours), and mortality was 35%. Thirty-three patients presented with malnutrition, and 61 developed hospital-acquired malnutrition, for an incidence of 47.7%. Malnutrition at any point was associated with longer duration of ECMO (median, 180 hours [IQR, 107.8-335.8 hours] vs 120 hours [IQR, 90-185.8 hours]; P < .001). Patients with hospital-acquired malnutrition required a 50% longer duration of ECMO (median, 182.5 hours [IQR, 101.5-367 hours] vs 123 hours [IQR, 90.8-211.5 hours]; P < .001). Preexisting malnutrition was associated with a nonsignificant increase in mortality (48.2% vs 32.9%; P = .13), which was similar after 3:1 propensity score matching (43.3% vs 35.4%; P = .44).

Conclusions

In adult patients, malnutrition appears to be associated with prolonged duration of VA ECMO. Adequately powered studies are needed to further investigate the relationship between malnutrition and mortality.

Graphical Abstract

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Author and article information

Contributors

Stacy Pelekhaty

Journal

Journal ID (nlm-ta): JTCVS Open

Journal ID (iso-abbrev): JTCVS Open

Title: JTCVS Open

Publisher: Elsevier

ISSN (Electronic): 2666-2736

Publication date PMC-release: 16 October 2024

Publication date Collection: December 2024

Publication date (Electronic): 16 October 2024

Volume: 22

Pages: 38-46

Affiliations

[a ]Department of Clinical Nutrition, University of Maryland Medical Center, Baltimore, Md

[b ]Department Perioperative Services, University of Maryland Medical Center, Baltimore, Md

[c ]Department of Pharmaceutical Services, University of Maryland Medical Center, Baltimore, Md

[d ]Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, Md

[e ]Department of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, Md

[f ]Department of Medicine, University of Maryland School of Medicine, Baltimore, Md

[g ]Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md

[h ]Department of Surgery, University of Maryland School of Medicine, Baltimore, Md

Author notes

[∗ ]Address for reprints: Stacy Pelekhaty, MS, RDN, LDN, Department of Clinical Nutrition, University of Maryland Medical Center, 22. S Greene St, Baltimore, MD 21201. spelekhaty@ 123456umm.edu

Article

Publisher Item ID: S2666-2736(24)00346-2

DOI: 10.1016/j.xjon.2024.09.029

PMC ID: 11704522

SO-VID: f6c153f6-b3ff-4ff7-af52-5ae10ea0152c

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date received : 25 April 2024

Date revision received : 17 September 2024

Date accepted : 19 September 2024