Percutaneous endoscopic gastrostomy tube placement in patients with extracorporeal membrane oxygenation

Article English OPEN
Hirose, Hitoshi ; Cobb, Ryan ; Jenoff, Jay S. ; Cavarocchi, Nicholas C. (2013)
  • Publisher: Co-Action Publishing
  • Journal: Mechanical Circulatory Support
  • Related identifiers: doi: 10.3402/mcs.v4i0.20093
  • Subject: ECMO; nutrition; PEG; anticoagulation
    mesheuropmc: surgical procedures, operative

Introduction: Inadequate nutritional support after mechanical circulatory device placement is known to increase postoperative infections and to decrease survival. The extracorporeal membrane oxygenation (ECMO) patients with complicated postoperative recovery may require long-term nutritional support using percutaneous endoscopic gastrostomy (PEG) tube feeding. In this study, the feasibility of PEG procedure on patients on ECMO was evaluated.Methods: Between November 2010 and July 2012, 43 patients were placed on venoarterial or venovenous ECMO for cardiogenic shock or severe respiratory failure. All of the long-term ECMO patients were supported with tube feeding. Four patients underwent PEG tube placement for long-term nutritional support while they were on ECMO. Procedure management consisted of cessation of anticoagulation 12 hours before and 12 hours after procedure. Anticoagulation was continued while on ECMO. Data were retrospectively analyzed to investigate complications related to the PEG placement.Results: The studied patients consisted of two males and two females with a mean age of 55.5±7.9 years. The interval of ECMO to PEG placement was a mean 16.8±4.2 days. The mean total length of ECMO support for these patients was 22.7±5.6 days. PEG was successfully performed in the operating room or bedside in all patients. There were no ECMO-device-related issues during or after the PEG procedure. There were no postoperative short-term or long-term PEG-related complications, such as, acute gastric bleeding or dislodgement of the PEG tube.Conclusions: PEG placement for ECMO patients can be done without increasing the risk of device or intra-abdominal organ injury with carefully coordinated efforts from both the intensive care team and surgical services.Keywords: ECMO; nutrition; PEG; anticoagulation(Published: 21 January 2013)Citation: Mechanical Circulatory Support 2013, 4: 20093 - http://dx.doi.org/10.3402/mcs.v4i0.20093
  • References (9)

    1. McClave SA, Martindale RG, Vanek WV, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr 2009; 33: 277 316.

    2. Xu ZW, Li YS. Pathogenesis and treatment of parenteral nutrition-associated liver disease. Hepatobiliary Pancreat Dis Int 2012; 11(6): 586 93.

    3. Newton M, Burnham WR, Kamm MA. Morbidity, mortality, and risk factors for esophagitis in hospital inpatients. J Clin Gastroenterol 2000; 30: 264 9.

    4. Kostadima E, Kaditis AG, Alexopoulos EI, Zakynthinos E, Sfyras D. Early gastrostomy reduces the rate of ventilatorassociated pneumonia in stroke or head injury patients. Eur Respir J 2005; 26: 106 11.

    5. Park RH, Allison MC, Lang J, Spence E, Morris AJ, Danesh BJ, et al. Randomized comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992; 304(6839): 1406.

    6. Payne KM, King TM, Eisenach JB. The technique of percutaneous endoscopic gastrostomy. A safe and costeffective alternative to operative gastrostomy. J Crit Illn 1991; 6: 611 9.

    7. Lamb K, Cowan S, Evans N, Pitcher H, Moritz T, Lazar M, et al. Successful management of bleeding complications in patients supported with extracorporeal membrane oxygenation with primary respiratory failure. Perfusion. 2012. [Epub ahead of print].

    8. Scott LK, Boudreaux K, Thaljeh F, Grier LR, Conrad SA. Early enteral feeding in adults receiving venovenous extracorporeal membrane oxygenation. JPEN J Parenter Enteral Nutr 2004; 28: 295 300.

    9. Lukas G, Davies AR, Hilton AK, Pellegrino VA, Scheinkestel CD, Ridley E. Nutritional support in adult patients receiving extracorporeal membrane oxygenation. Crit Care Resusc 2010; 12: 230 4.

  • Metrics
    No metrics available
Share - Bookmark