Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

Umei, Nao; Ichiba, Shingo

doi:10.1155/2017/9437452

Cited by 6 publications

(10 citation statements)

References 16 publications

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“…It is intended to be an alternative to intubation and mechanical ventilation. Venovenous ECMO as an alternative to intubation, as described in several studies and case reports, has demonstrated its potential in similar situations before [1][2][3][4][5][6]. Although venovenous ECMO is known for potential complications, this case demonstrates that the benefits may outweigh the treatment-associated risks in particular populations.…”

Section: Introductionmentioning

confidence: 68%

“…In this study, the group of most obese patients (six patients with an average BMI of 57.3 kg/m 2 ) had a 100 percent survival rate [5]. A recent case report presented a patient with a BMI of 60.2 kg/m 2 who suffered from obesity hypoventilation syndrome and fluid retention [4]. Because of the high mortality rates for mechanical ventilation in this patient population, the authors applied venovenous ECMO as an alternative to reducing CO 2 by intubation and subsequent mechanical ventilation.…”

Section: Introductionmentioning

confidence: 72%

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Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

Lederer¹,

Stalder²,

Tisljar³

et al. 2018

Swiss Med Wkly

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Morbid obesity plays an increasingly important role in healthcare. Patients who are severely obese often suffer from a range of medical problems. One problem is obesity-related hypoventilation syndrome with its resulting hypercapnia. We report a case of a 33-year-old female patient who was in an extraordinarily bad medical state, with severe hypercapnia (pCO2 15.1 kPa), sepsis, acute anuric kidney failure and resulting acidosis (pH 6.96). Her body mass index was 84 kg/m2. Her chances of survival were considered very low after failed attempts at noninvasive ventilation. Based on prior research, we refrained from intubation and chose venovenous extracorporeal membrane oxygenation to treat the hypercapnia. In the entire medical literature, we are not aware of a similarly extraordinary case of obesity-related hypoventilation syndrome that could finally be treated successfully. The idea behind this case report is to consider venovenous extracorporeal membrane oxygenation as an alternative to intubation in this patient collective.

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Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 72%

Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

Lederer¹,

Stalder²,

Tisljar³

et al. 2018

Swiss Med Wkly

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“…The association between BMI and mortality in VV-ECMO-particularly with respect to ARDS secondary to COVID-19 has yet to be thoroughly explored in the literature. Although few publications prior to the COVID-19 pandemic have demonstrated the feasibility of cannulation, suggested technical modifications to accommodate for increased flow requirements and reported favourable outcomes in obese adult patients placed on VV-ECMO, published results of cohorts with respiratory failure secondary to COVID-19 have predominantly consisted of patients with BMI less than 40 thus limiting awareness of outcomes in this patient population [10,16,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…Exploration of ECMO utilization in obese patients prior to the COVID-19 pandemic dates back to the early 2000's when case reports described the feasibility of cannulating the morbidly obese and subsequent reports of relatively comparable outcomes [15][16][17][18]. There have also been reports that obese patients on ECMO may have a higher rate of survival compared to non-obese patients; it is unclear if this applies to COVID-19 [19].…”

Section: Introductionmentioning

confidence: 99%

ECMO Cannulation Criteria in COVID-19 (ECC-VID) and Obesity: A Literature Review and Retrospective Cohort Analysis

Hassani¹,

Creel-Bulos²,

Connor³

et al. 2021

SCR

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Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) continues to be used as rescue therapy for patients with acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19). Although there is emerging literature on the use of and mortality associated with V-V ECMO in the management of patients with COVID-19, our understanding of who may benefit from this management strategy remains limited. Our clinicians sought to provide further insight into pre-cannulation characteristics and mortality in a cohort of patients with COVID-19 associated ARDS managed with V-V ECMO that primarily consisted of obese patients (90%, n=18) with a BMI of 30 kg/m2 or greater. Our findings not only revealed high survival to hospital discharge (70%, n=14) but demonstrated non-inferior outcomes and survival in obese patients. With an imminent next wave of rising infections, knowledge of which patients have a better chance of survival with the initiation of V-V ECMO is essential. Obese patients have been historically underrepresented in ECMO outcomes literature, but our findings suggest the utilization of ECMO for COVID-19 associated ARDS in these patient subsets should be considered and outcomes should be further explored.

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“…Venovenous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a therapeutic modality for the recovery of various refractory acute respiratory failure situations (9). However, few studies have reported the outcomes in patients with OHS and refractory respiratory failure treated with VV-ECMO (10). We sought to report the case of a patient with OHS, complicated with severe PH and acute respiratory failure, who underwent bridging treatment using VV-ECMO.…”

Section: Case Reportmentioning

confidence: 99%

Veno-venous extracorporeal membrane oxygenation rescue for pulmonary hypertension and hypoxemic respiratory failure to obesity hypoventilation syndrome: a case report

et al. 2022

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Background: Effective pharmacological options for acute hypoxemic or hypercapnic respiratory failure, associated with obesity hypoventilation syndrome (OHS), have not been fully elucidated. Although weight reduction, non-invasive ventilation (NIV), and continuous positive airway pressure (CPAP) lead to improvements in long-term clinical outcomes and cardiac function, there is no rapid reversal method in serious situations requiring mechanical ventilation. Veno-venous extracorporeal life support by extracorporeal membrane oxygenation is a widely used modality that can support patients with refractory hypoxemia or hypercapnia as a bridging therapy for recovery. Case Description: We present the case of a morbidly obese [body mass index (BMI) of 42 kg/m 2 ] 58-year-old man with refractory hypoxemic respiratory failure, resulting from severe right ventricular failure and pulmonary hypertension (PH), who underwent emergency support with extracorporeal membrane oxygenation. During extracorporeal life support and mechanical ventilation, careful diuresis and nutritional control were provided for body weight loss, and body weight was significantly reduced by approximately 30 kg. Nocturnal NIV was initiated immediately after cessation of positive pressure ventilation and endotracheal intubation. After 5 weeks of hospitalization, transthoracic echocardiography (TTE) showed robust improvements in right ventricular cardiac function and PH.Conclusions: Here, we describe that veno-venous extracorporeal life support may sufficiently support patients with obesity and sleep hypoventilation who have suffered a pulmonary hypertensive crisis.

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Venovenous Extracorporeal Membrane Oxygenation as a Treatment for Obesity Hypoventilation Syndrome

Cited by 6 publications

References 16 publications

Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

Venovenous extracorporeal membrane oxygenation to treat hypercapnia in a morbidly obese patient

ECMO Cannulation Criteria in COVID-19 (ECC-VID) and Obesity: A Literature Review and Retrospective Cohort Analysis

Veno-venous extracorporeal membrane oxygenation rescue for pulmonary hypertension and hypoxemic respiratory failure to obesity hypoventilation syndrome: a case report

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