Nutrition accrual on extracorporeal membrane oxygenation (ECMO) is the need of the hour. The crescendo interest in nutrition optimization on ECMO comes in the wake of the recent American Society for Parenteral and Enternal Nutrition (ASPEN) guidelines on pediatric patients.[1] Due to the technical hazards of ECMO, the presence of a multitude of inotropes, hemodynamic perturbations, and the risk of ischemic bowel, the association with nutrition therapy on ECMO is controversial.[2] The crescendo waxing and waning of feeding on ECMO are to be avoided. A recent review round-up of the literature assures that beginning enteral nutrition (EN) early in ECMO is secure and circumspect.[3]

Most of these indisposed ill ECMO patients have limited nutrients as endogenous stores; thus, it is important to administer nutritional support as early as possible in these moribund patients. So, relatively high nutritional requirements, with early institution of nutritional support, is important.[4] [5] This, however, is delayed in most intensive care unit (ICU) settings. So, EN is ideal as it stimulates the secretion of intestinal hormones.[6] As ECMO patients have limited nutritional reserves and high nutritional requirements are essential in these sick patients, early feeding on ECMO is essentially needed.[7] As EN is begun, multifold benefits appear, some of which are enlisted in [Table 1].