None listed
Conditions
Brief summary
ECMO is a form of advanced life support that is used in patients with heart or lung failure when other forms of medical treatment have failed. These patients are some of the sickest within Australian and New Zealand Intensive Care units (ICUs) and often remain unconscious for weeks. Whilst provision of nutrition via feeding tube into the stomach (enteral nutrition) is an accepted standard of care there remain crucial gaps in our understanding of the best way to provide nutrition to this population. Available data indicates that these patients consistently receive less nutrition than they are prescribed, and they experience frequent interruptions to nutrition delivery. Moreover, the outcomes in these patients are poor with significant losses of muscle mass and strength resulting in disability that persists well beyond hospital discharge. It is thought that nutrition delivery across hospitalisation may influence recovery, however this needs to be understood, with no information currently available for the period on the hospital ward. This study is designed to describe current nutrition provision and practices across hospitalisation for the first time in patients receiving ECMO. It is expected that the findings from this study will enable the develop of strategies to improve the delivery of nutrition in this high-risk population and inform the design of future research.
Interventions
Extracorporeal membrane oxygenation (ECMO) is commonly used as a salvage therapy for patients with refractory heart or lung failure when other medical management has failed. Despite nutrition therapy being an accepted standard of care within this population, there remains scant evidence to inform practice. Existing observational studies indicate that patients who receive ECMO consistently receive less nutrition than prescribed whilst in the Intensive Care Unit (ICU); however, the significance of
Extracorporeal membrane oxygenation (ECMO) is commonly used as a salvage therapy for patients with refractory heart or lung failure when other medical management has failed. Despite nutrition therapy being an accepted standard of care within this population, there remains scant evidence to inform practice. Existing observational studies indicate that patients who receive ECMO consistently receive less nutrition than prescribed whilst in the Intensive Care Unit (ICU); however, the significance of this in relation to clinical outcomes remains to be explored. Moreover, patients typically experience significant losses of muscle mass, strength, and debilitating fatigue resulting in persistent disability after hospital discharge. Given the prolonged length of ICU and hospital stay for patients receiving ECMO, it is plausible nutrition provision across hospitalisation may represent a modifiable factor that has the potential to alter outcomes and influence recovery. However, no studies have explored nutrition provision following ICU discharge in patients who received ECMO. Thus, the aim of this prospective registry linked cohort study is to describe current nutrition delivery practices and provision in patients receiving ECMO in Australia across hospitalisation between June 2022-September 2023 and explore the association between nutrition provision with clinical and long-term outcomes. Additionally, this study will explore changes in nutrition provision over the last decade in patients who have received ECMO in Australia via comparison with a previous data set. To streamline processes the study is linked with a pre-existing national registry (The Australian and New Zealand extracorporeal membrane oxygenation registry [EXCEL]) to obtain data on baseline and long term clinical and functional outcomes. Data on nutrition delivery processes and provision will be collected at each site (including mode, barriers and enablers) via review of patient medical records until day 60, acute hospital transfer or death (whichever occurs earliest). Data at 6 months will be extracted from the EXCEL registry. The EXCEL registry follow up data is collected by trained assessors using telephone interviews including responses to the following instruments: Quality of life assessed using the EQ-5D-5L questionnaire Physical activity assessed using the Instrumental Activities of Daily Living (IADL) questionnaire and Barthel Activities of Daily Living (ADL) index
Sponsors
Australian and New Zealand Intensive Care Research Centre (ANZIC-RC)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
• Receiving ECMO in an adult hospital • Enrolled in the EXCEL registry
Exclusion criteria
Receiving ECMO for the purpose of ECPR (Extracorporeal cardiopulmonary resuscitation)
Outcome results
None listed