ECMO Nutrition and Metabolic Management in ECMO 1 — Questions and Answers
Question 1: What is the preferred route of nutritional support for hemodynamically stable ECMO patients?
- Total parenteral nutrition via central line
- Enteral nutrition via nasogastric or nasoenteric tube (Correct answer)
- Peripheral parenteral nutrition
- Oral feeding once sedation is reduced
Correct answer: Enteral nutrition via nasogastric or nasoenteric tube
Enteral nutrition is preferred in stable ECMO patients because it preserves gut integrity, reduces infection risk, and is associated with better outcomes compared to parenteral routes.
Question 2: What is the recommended protein target for ECMO patients to support recovery and minimize muscle catabolism?
- 0.5–0.8 g/kg/day
- 1.0–1.2 g/kg/day
- 1.5–2.0 g/kg/day (Correct answer)
- 2.5–3.0 g/kg/day
Correct answer: 1.5–2.0 g/kg/day
ECMO patients are in a hypercatabolic state, and current guidelines recommend 1.5–2.0 g/kg/day of protein to support nitrogen balance and minimize muscle wasting.
Question 3: Which metabolic disturbance is most commonly associated with ECMO-induced systemic inflammatory response?
- Hypoglycemia
- Hyperglycemia (Correct answer)
- Hyponatremia
- Hypercalcemia
Correct answer: Hyperglycemia
The systemic inflammatory response triggered by contact activation during ECMO promotes insulin resistance and stress hyperglycemia, making it the most common metabolic disturbance.
Question 4: When initiating enteral nutrition in an ECMO patient, what is the recommended timing after circuit initiation in a hemodynamically stable patient?
- Immediately within 1 hour
- Within 24–48 hours (Correct answer)
- After 72 hours once vasopressors are weaned
- Only after ECMO flows are reduced below 3 L/min
Correct answer: Within 24–48 hours
Early enteral nutrition within 24–48 hours of ECMO initiation is recommended in hemodynamically stable patients to reduce gut ischemia and support immunity.
Question 5: Which caloric target is most appropriate for an ECMO patient using a permissive underfeeding strategy in the acute phase?
- 100–120% of estimated energy expenditure
- 70–80% of estimated energy expenditure (Correct answer)
- 50–60% of estimated energy expenditure
- 150% of estimated energy expenditure
Correct answer: 70–80% of estimated energy expenditure
Permissive underfeeding targeting 70–80% of energy expenditure during the acute phase avoids overfeeding complications such as hyperglycemia and lipogenesis while still providing metabolic support.
Question 6: How does the ECMO circuit most directly impact drug and nutrient pharmacokinetics?
- It increases renal clearance of lipid-soluble compounds
- It sequesters lipophilic drugs and nutrients within the circuit tubing and oxygenator (Correct answer)
- It accelerates hepatic metabolism of protein-bound compounds
- It reduces the volume of distribution for hydrophilic medications
Correct answer: It sequesters lipophilic drugs and nutrients within the circuit tubing and oxygenator
Lipophilic drugs and nutrients bind to the polyvinyl chloride tubing, silicone membranes, and oxygenator of the ECMO circuit, reducing effective plasma concentrations.
Question 7: Which monitoring parameter is most useful for assessing adequacy of nutrition support and metabolic response in ECMO patients?
- Serum albumin levels weekly
- Indirect calorimetry measurement (Correct answer)
- Daily urine urea nitrogen excretion only
- Body weight measured every 48 hours
Correct answer: Indirect calorimetry measurement
Indirect calorimetry provides the most accurate measure of resting energy expenditure in ECMO patients, guiding precise caloric prescription and avoiding over- or underfeeding.
ECMO Nutrition and Metabolic Management in ECMO 1
What is the preferred route of nutritional support for hemodynamically stable ECMO patients?