Nutrition implications and challenges of the transplant patient undergoing extracorporeal membrane oxygenation therapy.

Extracorporeal membrane oxygenation (ECMO) is used to treat patients with severe acute respiratory distress syndrome or severe cardiac and/or respiratory failure that is unresponsive to conventional ventilator therapy. Provision of adequate nutrition support can be challenging due to hemodynamic alterations encountered in these critically ill patients. Although ECMO is an established therapy for many aspects of organ transplant in the pre- and posttransplant phases, there is a paucity of published data for this patient population. Clinical guidelines are available for the nutrition support of neonates supported with ECMO, but no guidelines have been established for the adult population receiving ECMO support. Review of published reports and personal experience indicates that early enteral nutrition support can be well tolerated by transplant patients receiving either venovenous or venoarterial ECMO, if care is taken to adequately assess potential barriers to optimal nutrition support. Until specific guidelines are developed for patients receiving ECMO, it appears that the guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient provide the best guidance for the nutrition support clinician who is caring for the patient receiving ECMO support.