Abstract 4368598: Nutrition in the Cardiac Intensive Care Unit: Insights from a Survey of the Critical Care Cardiology Trials Network

Background: Nutrition is a vital component of recovery for critically ill cardiac patients. However, there is a substantial lack of evidence, consensus, and guidelines regarding optimal nutrition strategies for critically ill cardiac patients, particular those presenting with cardiogenic shock. Methods: The Critical Care Cardiology Trials Network (CCCTN) is an international multicenter research network consisting of advanced cardiac intensive care units (CICUs). A nutrition-based survey was distributed to CCCTN sites in 2024-2025. Results: A total of 43 sites responded to the survey. ASPEN nutrition guidelines are most commonly used to inform local protocols and nutrition practice (86%) however a large portion of sites also follow individual institutional protocols (65%). For malnourished patients, 49% of sites initiate nutrition 24-48 hours after admission, compared with 44% for non-malnourished patients. Most sites initiate enteral nutrition at a low rate and advance to goal hourly rates, reported at 88% of sites for malnourished and 93% for non-malnourished patients. Severity of cardiogenic shock influences the decision to initiate tube feeding at 91% of sites, with SCAI D and E very frequently delaying tube feeding. Elevated protein targets (1.5–2.0 g/kg/day) are prescribed at 47% of sites for malnourished patients and 12% of sites for non-malnourished patients. Supplemental parenteral nutrition (SPN) is sparsely used for malnourished patients, or when reaching EN is challenging with 7% of sites starting SPN at baseline and 49% starting SPN if energy and protein targets cannot be achieved. The PN formula used varies with 30% of sites using mixed oil intravenous lipid emulsion (ILE) without fish oil, 74% using Mixed oil ILE with fish oil, and 28% using 100% soybean oil ILE . Conclusions: There is significant variability in nutrition practices across contemporary North American CICUs. The severity of cardiogenic shock (SCAI D/E) prompted sites to delay initiation of nutrition. Despite recent data suggesting harm from high dose protein supplementation and benefit from a mixed oil/fish oil ILE for critically ill patients, > 45% of sites employed high protein targets and over a quarter of sites employed 100% soybean oil ILE.