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Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study

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Abstract

Purpose

Despite extensive research on enteral nutrition (EN) for patients in shock, it remains unclear whether this should be postponed in patients with cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO). In this study, we aimed to compare outcomes of early and delayed EN for patients with cardiogenic or obstructive shock requiring VA-ECMO.

Methods

In this retrospective database study drawing on the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2016, we identified patients with cardiogenic or obstructive shock who had received VA-ECMO for more than 2 days. We allocated the patients to two groups: those who received EN within 2 days (early) or 3 days or more (delayed) after starting VA-ECMO. We then used a marginal structural model to analyze associations between early EN and various outcomes, including in-hospital mortality and 28-day mortality.

Results

We identified 1769 eligible patients during the 69-month study period, 220 of whom (12%) received early EN. After using a marginal structural model to adjust for baseline and time-dependent confounders, we found that the early EN group showed significantly lower in-hospital mortality [hazard ratio 0.78, 95% confidence interval (95% CI) 0.62–0.98, P = 0.032] and lower 28-day mortality (hazard ratio 0.74, 95% CI 0.56–0.97, P = 0.031) than the delayed EN group.

Conclusions

According to this retrospective database study, early EN is not associated with harm but rather with lower mortality in patients with cardiogenic or obstructive shock requiring at least 2 days of VA-ECMO.

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Acknowledgements

This work was supported by grants from the Ministry of Health, Labour and Welfare of Japan (H29-Policy-Designated-009 and H29-ICT-General-004); Ministry of Education, Culture, Sports, Science and Technology of Japan (17H04141); and Japan Agency for Medical Research and Development.

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Authors and Affiliations

  1. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan

    Hiroyuki Ohbe, Hiroki Matsui & Hideo Yasunaga

  2. Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Taisuke Jo & Hayato Yamana

  3. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan

    Kiyohide Fushimi

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  1. Hiroyuki Ohbe
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  2. Taisuke Jo
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  3. Hayato Yamana
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  4. Hiroki Matsui
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  5. Kiyohide Fushimi
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Correspondence to Hiroyuki Ohbe.

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Ohbe, H., Jo, T., Yamana, H. et al. Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. Intensive Care Med 44, 1258–1265 (2018). https://doi.org/10.1007/s00134-018-5319-1

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  • DOI: https://doi.org/10.1007/s00134-018-5319-1

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