Association between parenteral nutrition and extracorporeal membrane oxygenation circuit dysfunction in critically ill adults requiring extracorporeal life support: A retrospective cohort study

Background: Extracorporeal life support is influenced by membrane integrity and nutrition. The impact of parenteral nutrition with lipid injectable emulsions on membrane function remains uncertain. Methods: This retrospective cohort included 151 critically ill adults receiving extracorporeal life support at a single center. Patients were classified based on exposure to parenteral nutrition: those exposed to parenteral nutrition (n = 38, 25%) and those not exposed to parenteral nutrition (n = 113, 75%). Data included demographics, clinical, biochemical, and extracorporeal membrane oxygenation–related variables. Our primary outcome was time to first extracorporeal membrane oxygenation circuit dysfunction; secondary outcomes were extracorporeal life support duration, metabolic changes, and transfusion needs, analyzed with Kaplan-Meier curves and Cox models. Results: Extracorporeal membrane oxygenation circuit life span was similar between groups (8.5 vs 7 days, P = 0.079). Replacement occurred in 18 patients (11.9%): 7 (18.4%) with parenteral nutrition and 11 (9.7%) without. Multivariate analysis showed a hazard ratio (HR) of 2.35 for membrane replacement in parenteral nutrition patients (CI 0.71–7.69, P = 0.157). The parenteral nutrition group had higher D-dimer (3470 vs 650 ng/ml, P = 0.06), lower fibrinogen (159 vs 308 mg/dl, P = 0.05), longer extracorporeal life support (10 vs 7 days, P = 0.047). Parenteral nutrition was also linked to elevated peak triglycerides (352 vs 261 mg/dl, P < 0.01) and lower HDL (14.5 vs 22 mg/dl, P < 0.01). However, these metabolic changes did not significantly impact membrane replacement (HR 0.99, CI 0.99–1.00, P = 0.817). Conclusions: Although membrane dysfunction seemed more frequent in the parenteral nutrition group, evidence was insufficient to confirm an association, underscoring the need for further research.