Nutritional Support Patterns and Outcomes in Pediatric Veno-Venous and Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Analysis

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BACKGROUND: Nutritional support in patients receiving extracorporeal membrane oxygenation (ECMO) is a clinical challenge. Hemodynamic instability and concerns about gut perfusion delay enteral nutrition (EN), resulting in frequent use of total parenteral nutrition (TPN). This study aimed to compare nutritional practices in patients on venoarterial (VA) vs. venovenous (VV) ECMO, and to evaluate the associations between prolonged TPN use, feeding status, circuit change frequency, length of stay, and survival. METHODS: Retrospective cohort study of ECMO patients in a quaternary pediatric intensive care unit. Nutritional variables included route and amount of nutrition delivery. The primary outcome was the nutrition type (enteral vs. parenteral) in association with ECMO mode (VV vs. VA). Secondary outcomes included associations between nutrition variables (TPN by Day 14, lack of EN by Day 5 or 7) and circuit changes, ECMO duration, ICU/hospital length of stay (LOS), and mortality. Analyses by Mann-Whitney and chi-square tests. Multivariable Poisson regression was used to identify independent predictors of circuit change frequency. RESULTS: Patients on VV ECMO achieved higher enteral intake than those on VA ECMO. Persistent need for TPN by Day 14 was associated with longer PICU LOS, hospital LOS, and ECMO duration and was independently associated with 71% higher circuit change frequency. Survival did not differ significantly by TPN duration or early EN exposure. CONCLUSIONS: VV ECMO patients received higher enteral nutrition. Persistent need for TPN by day 14 was associated with worse outcomes. These findings underscore the need for standardized, evidence-based feeding strategies in this population.

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