Abstract
International guidelines for the nutrition management of critically ill adults do not sufficiently cover the unique challenges and considerations of patients receiving extracorporeal membrane oxygenation (ECMO). The aim of the current guideline is to assess the literature informing nutrition provision and practice for patients receiving ECMO and provide clinicians with consensus-based recommendations to inform clinical practice. A group of international experts was convened by the Extracorporeal Life Support Organization (ELSO) to systematically develop consensus-based recommendations for nutrition therapy. Questions of interest were developed by the authors based on those included in guideline recommendations for general critically ill patients on key clinical areas of nutrition provision and practice during critical illness, but specific to the context of patients receiving ECMO. Following question development, a systematic review of the literature was undertaken, recommendations were developed accordingly, and blind voting was undertaken to determine consensus. Study quality was assessed using the National Institute for Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A total of 31 publications informed the recommendations with no randomized controlled trials found. Sixteen consensus-based recommendations were formulated for 10 clinical questions, of which 11 reached "strong consensus" (100%) and five "consensus" (87.5%). A total of 26 studies were eligible for quality assessment with 24 (92.3%) rated "fair," 1 (3.8%) rated "good," and 1 (3.8%) rated "poor." There is limited high-level evidence to inform nutrition practice in adult patients receiving ECMO. However, these consensus recommendations have been developed using the available observational data, relevant studies of nutrition in general critically ill patients, and the clinical expertise of those working in high-volume ECMO centers and will help to guide nutrition practices in this patient group.