The Five-Day Trajectory of Nutritional Indicators and Influencing Factors in Adult Patients After VA-ECMO: A Prospective Observational Study.

Objective: This study aimed to characterize the 5-day trajectory of nutritional and metabolic profiles and identify influencing factors in adults receiving VA-ECMO support. Methods: A total of 46 patients with cardiogenic shock receiving VA-ECMO (2022-2024; median age 50 [IQR: 41.0-63.3]) were prospectively enrolled. Demographic, clinical, nutritional, and metabolic biomarkers were serially collected over 5 days. Multivariate analysis was employed to evaluate longitudinal trends and determinants of change. Results: Significant dynamic changes were observed in nutritional and metabolic parameters, including serum albumin, neutrophil count, prognostic nutrition index (PNI), triceps skinfold thickness, and mid-upper arm circumference. A marked decline in albumin occurred within the first 48 h (mean differences: -5.663, p = 0.035; -5.728, p = 0.003). Age and hyperlipidemia were independent factors affecting albumin levels (p < 0.001 and p = 0.032, respectively). Progressive reductions in skinfold thickness and arm circumference were noted from day 2 to day 5 (p < 0.001). Conclusions: ECMO support is associated with early changes in nutritional status. Rapid albumin decline within 48 h and later anthropometric reductions suggest a need for prompt nutritional monitoring and individualized intervention, though further validation is warranted. Implications for Clinical Practice: These findings highlight the critical importance of integrated nutritional and metabolic management initiated early during VA-ECMO support to improve patient outcomes.