The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency

Merritt-Genore, HelenMari; Lyden, Elizabeth; Ryan, Timothy; Kwapnoski, Zachary

doi:10.1111/jocs.14579

Cited by 10 publications

(16 citation statements)

References 11 publications

(21 reference statements)

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“…Genore et al reported that there was no difference in mortality and other significant complications in patients with different weight classes when stratified between venovenous ECMO and venoarterial ECMO [31]. is finding was similar to the conclusion of a much more extensive review of ELSO registry by Kon et al in 2017, where he reported that venovenous ECMO was not associated with worse outcomes or complications than venoarterial ECMO for ARDS [38].…”

Section: Discussionmentioning

confidence: 52%

“…All studies that were included in this analysis showed that there was no added mortality risk in obese patients when treated with ECMO therapy as compared to nonobese patients. e primary outcome compared in our analysis was "successful weaning from ECMO," and this outcome was reported in the main article or supplementary material of Cho et al [27], Dalia et al [28], Eunmi et al [29], Genore et al [31], and Salna et al [32].…”

Section: Findings and Resultsmentioning

confidence: 99%

“…All six studies (Cho et al [27], Dalia et al [28], Eunmi et al [29], Galvagno et al [30], Genore et al [31], and Salna et al [32]) were included in the secondary analysis to compare survival to hospital discharge for patients on ECMO and its association with obesity. Since the heterogeneity in this analysis was significant, a random-effect model was used.…”

Section: Findings and Resultsmentioning

confidence: 99%

“…e six studies included in the review and meta-analysis were by Cho et al [27], Dalia et al [28], Eunmi et al [29], Galvagno et al [30], Genore et al [31], and Salna et al [32] (Table 1). In all 6 studies, there were no patients excluded from ECMO therapy due to other systemic illnesses, such as diabetes mellitus and chronic hypertension.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Genore et al [31] retrospectively reviewed charts of 231 patients who received ECMO support. ey reported their findings as outcomes of survival to hospital discharge, mortality, length of stay, length of ECMO therapy, weaning from ECMO, and length of ICU stay, as stratified by BMI class.…”

Section: Description Of Studiesmentioning

confidence: 99%

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Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

Zaidi

Saleem

2021

Canadian Respiratory Journal

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Purpose. Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods. We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m2 (obese) and BMI < 30 kg/m2 (nonobese). Results. In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi2 = 7.44, df = 4 ( p = 0.11 ), I2 = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau2 0.03, chi2 = 14.61, df = 5 ( p = 0.01 ), I2 = 66%). Conclusion. Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.

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Section: Discussionmentioning

confidence: 52%

Section: Findings and Resultsmentioning

confidence: 99%

Section: Findings and Resultsmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

Zaidi

Saleem

2021

Canadian Respiratory Journal

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Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study

et al. 2022

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Purpose The impact of body mass index (BMI) on outcomes in respiratory failure necessitating extracorporeal membrane oxygenation (ECMO) has been poorly described. We aimed to assess: (i) whether adults with class II obesity or more (BMI ≥ 35 kg/m 2 ) have worse outcomes than lean counterparts, (ii) the form of the relationship between BMI and outcomes, (iii) whether a cutoff marking futility can be identified. Methods A retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry from 1/1/2010 to 31/12/2020 was conducted. Impact of BMI ≥ 35 kg/m 2 was assessed with propensity-score (PS) matching, inverse propensity-score weighted (IPSW) and multivariable models (MV), adjusting for a priori identified confounders. Primary outcome was in-hospital mortality. The form of the relationship between BMI and outcomes was studied with generalized additive models. Outcomes across World Health Organisation (WHO)-defined BMI categories were compared. Results Among 18,529 patients, BMI ≥ 35 kg/m 2 was consistently associated with reduced in-hospital mortality [PS-matched: OR: 0.878(95%CI 0.798–0.966), p = 0.008; IPSW: OR: 0.899(95%CI 0.827–0.979), p = 0.014; MV: OR: 0.900(95%CI 0.834–0.971), p = 0.007] and shorter hospital length of stays. In patients with BMI ≥ 35 kg/m 2 , cardiovascular (17.3% versus 15.3%), renal (37% versus 30%) and device-related complications (25.7% versus 20.6%) increased, whereas pulmonary complications decreased (7.6% versus 9.3%). These findings were independent of confounders throughout PS-matched, IPSW and MV models. The relationship between BMI and outcomes was non-linear and no cutoff for futility was identified. Conclusion Patients with obesity class II or more treated with ECMO for respiratory failure have lower mortality risk and shorter stays, despite increased cardiovascular, device-related, and renal complications. No upper limit of BMI indicating futility of ECMO treatment could be identified. BMI as single parameter should not be a contra-indication for respiratory ECMO. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06926-4.

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The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

Borggrefe¹,

Svobodová²,

Pořízka³

et al. 2022

Journal of Critical Care

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The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency

Cited by 10 publications

References 11 publications

Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

Obesity as a Risk Factor for Failure to Wean from ECMO: A Systematic Review and Meta-Analysis

Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study

The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

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