A third of intensive care patients on ECMO life support cannot absorb food through their stomachs, and this study will test whether feeding tubes placed directly into the small intestine can bypass the problem. Delayed gastric emptying is common in critical illness, but its true prevalence in ECMO patients—who often stay in intensive care for weeks—has never been measured. The current gold-standard diagnostic test, scintigraphy, requires radioactive tracers and bulky scanners that cannot be used at the bedside. This project will compare two simpler methods—gastric ultrasound and measuring residual stomach volumes—against scintigraphy in 27 ECMO patients to find an accurate, practical alternative. If successful, the research will provide the first reliable bedside tool for detecting delayed gastric emptying in ECMO patients and determine whether early small-bowel feeding is feasible and acceptable in a future large-scale trial. Better nutrition during ECMO could shorten ICU stays, reduce muscle wasting, and improve long-term physical function for survivors. The findings will also inform feeding protocols for the growing number of patients placed on ECMO worldwide.
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Research questions Is delayed gastric emptying (DGE) prevalence greater in intensive care unit (ICU) patients receiving extracorporeal membrane oxygenation (ECMO) than patients not receiving ECMO? What is the best bedside method to accurately measure DGE in ECMO patients? Is a randomised controlled trial (RCT) investigating early nasojejunal vs nasogastric feeding to manage DGE in ECMO patients feasible? Background Patients receiving ECMO experience extended ICU stays and post-ICU functional deficits. Adequate nutrition in ICU is associated with improved clinical outcomes and physical function. However, achieving nutritional adequacy during ECMO is challenging due to gastrointestinal intolerance, often resulting from DGE. Scintigraphy is the 'gold-standard' method for measuring DGE, but is unsuitable for routine ICU clinical use and has never been investigated in ECMO. Nasojejunal feeding is associated with improved gastrointestinal tolerance and nutritional adequacy in ICU, and has potential as primary strategy for managing DGE in ECMO patients. Aims/objectives To investigate DGE prevalence in ICU patients receiving ECMO vs no ECMO, and associated nutritional consequences (work package [WP] 1a) To identify an accurate bedside method for measuring DGE compared with gold-standard scintigraphy (WP1b) To evaluate the feasibility and acceptability of an RCT of early nasojejunal vs nasogastric feeding during ECMO (WP2) Methods In WP1a, I will undertake an observational study in two London ECMO ICUs, recruiting 72 patients over 12 months (36 ECMO; 36 non-ECMO). I will include mechanically ventilated adults (≥18 years) with cardiac/respiratory failure receiving enteral nutrition (EN) and expected to remain in ICU >72h. DGE prevalence in ECMO vs non-ECMO patients will be measured at pre-defined intervals using (a) gastric ultrasound, and (b) gastric residual volumes (GRVs), within 4 days of admission. Differences in secondary gastrointestinal complications and EN delivery will be explored. In WP1b, a subgroup of 27 ECMO patients will also have gastric emptying measured via scintigraphy, using a radiolabelled EN formula and a portable γ-camera. I will identify the bedside method (gastric ultrasound or GRVs) with highest specificity and sensitivity in detecting DGE compared with scintigraphy. In WP2, I will conduct a feasibility RCT recruiting 30 ECMO patients over 10 months. Patients will be randomised to early nasojejunal or nasogastric feeding (usual care) within 48h of admission. I will collect feasibility outcomes (recruitment/retention, intervention delivery, data collection) and exploratory nutritional, clinical, and physical function outcomes during ICU and at 30 and 90-day follow-up. I will conduct semi-structured interviews to explore acceptability with patients/caregivers and ICU nurses, based on the Theoretical Framework of Acceptability. Anticipated impact/dissemination My Fellowship will determine DGE prevalence in ECMO, identify an accurate bedside method for measuring DGE, and determine the feasibility, acceptability and primary outcomes of an adequately powered RCT exploring early nasojejunal vs nasogastric feeding. Findings will be disseminated through high-impact journal publications, national/international conference presentations, and shared via advocacy organisations and social media. My Patient and Public Involvement/Engagement group will also play a crucial role in ensuring diverse dissemination, including lay summaries and infographics/animations for patients and families. Delivery timelines WP1 (WP1a/WP1b): April 2025-January 2027 WP2: April 2026-March 2028
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