George Lukas

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research.

Background: Patients receiving extracorporeal membrane oxygenation (ECMO) are some of the most critically ill in the intensive care unit. In such patients, malnutrition is associated with increased morbidity and mortality. Objectives: To describe the use, methods and adequacy of nutritional support in a consecutive group of patients receiving ECMO; to determine differences between the periods during and after ECMO support; and to determine differences in nutritional adequacy between ECMO survivors and ECMO non-survivors. Design, setting and participants: We conducted a retrospective study of patients who received ECMO at the Alfred Hospital between January 2005 and December 2007. Patients who received venoarterial (VA) or venovenous (VV) ECMO had their case notes reviewed for clinical and nutritional outcomes. Nutritional adequacy was defined as the ratio of delivered nutrition to target nutrition, expressed as a percentage. Results: Of 48 patients included in our analysis, 35 had VA ECMO and 13 had VV ECMO. Overall, the mean nutritional adequacy achieved for all patients over the periods during and after ECMO support was 62% (SD, 19%). Nutritional adequacy was lower during ECMO support (55%) than after ECMO removal (71%) (P = 0.003). Survivors did not achieve better nutritional adequacy than non-survivors (52% v 61%; P = 0.345). Conclusions: Patients receiving ECMO received inadequate nutritional support, with only 55% of their nutritional targets being achieved while receiving ECMO. Optimal nutritional support should be a major goal in the care of these patients, and measures to improve nutritional delivery require careful consideration.

OBJECTIVES: To describe current nutrition delivery practices and to identify barriers to nutrition in patients receiving venovenous or venoarterial extracorporeal membrane oxygenation (ECMO) in multiple centres in Australia and New Zealand. DESIGN, SETTING AND PARTICIPANTS: A prospective, multicentre, observational study, set in eight intensive care units in Australia and New Zealand, of adults treated with ECMO who were expected to receive enteral nutrition (EN) or parenteral nutrition (PN) therapy for > 72 hours. Data were collected from the start of ECMO until 7 days after ECMO cessation. RESULTS: There were 107 patients enrolled, with a median age of 42 years (interquartile range [IQR], 31-56 years), and 54 patients (50%) were men. EN was the most commonly delivered mode of nutrition (on 84% of days) although it was interrupted on 53% of days. The median interruption duration was 8 hours (IQR, 4-5 hours] per episode. The two most common barriers to EN delivery were fasting for a therapeutic or diagnostic procedure and high gastric residual volumes. Median daily calorie and protein deliveries from EN and/or PN were 1680 kcal (IQR, 960-2100 kcal) and 72 g (IQR, 42-98 g) of protein. For patients who received EN and/or PN, median calorie and protein deficits during the study period were -7118 kcal (IQR, -11 614 to -4510 kcal) and -325 g (IQR, - 525 to -188 g) of protein. CONCLUSIONS: EN was the most commonly used nutrition-delivery mode during ECMO treatment but was frequently interrupted. Compared with estimated calorie and protein requirements, lesser but reasonably acceptable amounts were delivered, although calorie and protein deficits still existed.