[A case report of nutritional therapy guided by metabolic cart monitoring in a patient with extracorporeal membrane oxygenation].

Patients supported by extracorporeal membrane oxygenation (ECMO) are often in a state of severe hypermetabolism and hypercatabolism, making nutritional support difficult, and there are significant deviations in estimating energy consumption by traditional formulas. On May 1, 2025, a 42-year-old male patient with acute extensive anterior myocardial infarction was admitted to the First Dongguan Affiliated Hospital of Guangdong Medical University. After admission, the patient underwent coronary stent implantation, and subsequently developed severe complications such as cardiac failure, cardiogenic shock and electrical storm, with an Acute Physiology and Chronic Health Evaluation II of 34 points. A series of invasive supportive treatments were successively administered to the patient, including tracheal intubation with mechanical ventilation, intra-aortic balloon pump (IABP), veno-arterial ECMO (VA-ECMO), continuous renal replacement therapy (CRRT) and cardiac pacemaker implantation. During the treatment, resting energy expenditure (REE) of the patient was monitored in real time by metabolic cart (indirect calorimetry), and the monitoring results were compared with those calculated by the traditional Harris-Benedict formula. Individualized nutritional support regimens were formulated based on the metabolic cart monitoring data: the ratio of enteral to parenteral nutrition was 1 : 2 during VA-ECMO treatment, and adjusted to 2 : 1 in the late post-weaning period with the addition of ω-3 polyunsaturated fatty acids. Meanwhile, an integrated traditional Chinese and Western medicine approach was adopted to regulate gastrointestinal function and repair digestive tract damage. Monitoring results showed that the REE value measured by metabolic cart decreased to one-third of the pre-VA-ECMO level during VA-ECMO treatment, which was correlated with ECMO machine parameters. Various invasive treatments exerted complex effects on the body's nutritional and metabolic status and also interfered with the monitoring indicators of the metabolic cart. Guided by metabolic cart monitoring, precise nutritional therapy was implemented in combination with multidisciplinary comprehensive treatment, which maintained the patient's metabolic stability, promoted the gradual improvement of organ functions, and laid a solid foundation for successful weaning from supportive devices and favorable prognosis. This case suggests that individualized clinical nutritional therapy under the guidance of metabolic cart is conducive to optimizing energy supply for ECMO patients and improving clinical outcomes, thus possessing important clinical application value.