Percutaneous endoscopic gastrostomy tube placement in patients with extracorporeal membrane oxygenation

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.