Should Patients with Severe Obesity Receive Veno-venous Extra Corporeal Membrane Oxygenation Support in Patients with Acute Respiratory Distress Syndrome? A Single-center Experience

Azmeen, Ayesha; Gadela, Naga Vaishnavi; Drake, Colleen; Kurtzman, Ethan; Underhill, David; Baker, William L.; Gluck, Jason A.; Jaiswal, Abhishek

Background Severe obesity (Body Mass Index (BMI) ≥40 kg/m2) is associated with a higher risk of developing severe symptoms and complications of coronavirus disease 19 (COVID-19), independent of other illnesses. Despite this, patients with severe obesity are less likely to receive Veno-Venous Extra Corporeal Membrane Oxygenation (VV-ECMO) support for severe Acute Respiratory Distress Syndrome (ARDS). Given this paradox, we examined the impact of severe obesity on outcomes of adult patients who underwent VV-ECMO implantation for ARDS at our center. Methods We reviewed our ECMO database from May 2013 through May 2020. Adults, who had received VV-ECMO, either in-house or through our mobile ECMO program, were included. We grouped patients into those with BMI ≥40 kg/m2 or not and compared survival at 48 hours, survival to hospital discharge, and hospital length of stay. We conducted multiple logistic and linear regression analyses to analyze the association with categorical and continuous variables, respectively, controlling for patient age, gender, and use of mobile ECMO. Results We identified 112 consecutive adult VV-ECMO patients; median age was 48 (34, 59) years, 61 (54.5%) were male, 56 (50%) were started on ECMO in-house, the median BMI was 31.7 (27.6, 38.8) Kg/ m2; and 23 (20.5%) had a BMI ≥40 kg/m2. Survival at 48 hours and hospital discharge were 69.6% and 61.6%, respectively; and, median hospital length of stay was 20 (9, 33) days. Logistic regression showed no evidence of an association between severe obesity and either 48-hour (OR 1.04, 95% CI 0.37-2.96) or hospital discharge survival (OR 1.06, 95% CI 0.38-2.93). There was, however, a significant correlation between increasing BMI and longer total hospital length of stay (R2 = 0.34; p = 0.0002) which remained significant in linear regression (p = 0.0002) (Figure). Conclusions We found no association between severe obesity and survival at 48-hour and hospital discharge in patients supported on VV-ECMO. Severe obesity was associated with a longer hospital stay, however. Our experience suggests that severe obesity alone should not exclude candidacy for VV-ECMO support.