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Multicenter Study
. 2023 Sep 15;208(6):685-694.
doi: 10.1164/rccm.202212-2293OC.

Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation: The Multicenter ECMObesity Study

Darya Rudym  1 , Tài Pham  2   3 , Craig R Rackley  4 , Giacomo Grasselli  5   6 , Michaela Anderson  7 , Matthew R Baldwin  8 , Jeremy Beitler  8   9 , Cara Agerstrand  8   9 , Alexis Serra  8 , Lisle A Winston  10 , Desiree Bonadonna  11 , Natalie Yip  8   9 , Logan J Emerson  12 , Amy Dzierba  9   13 , Joshua Sonett  14 , Darryl Abrams  8   9 , Niall D Ferguson  15   16   17   18   19   20 , Matthew Bacchetta  21 , Matthieu Schmidt  22   23 , Daniel Brodie  24 ; LIFEGARDS collaborators
Collaborators, Affiliations
Multicenter Study

Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation: The Multicenter ECMObesity Study

Darya Rudym et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Patients with obesity are at increased risk for developing acute respiratory distress syndrome (ARDS). Some centers consider obesity a relative contraindication to receiving extracorporeal membrane oxygenation (ECMO) support, despite growing implementation of ECMO for ARDS in the general population. Objectives: To investigate the association between obesity and mortality in patients with ARDS receiving ECMO. Methods: In this large, international, multicenter, retrospective cohort study, we evaluated the association of obesity, defined as body mass index ⩾ 30 kg/m2, with ICU mortality in patients receiving ECMO for ARDS by performing adjusted multivariable logistic regression and propensity score matching. Measurements and Main Results: Of 790 patients with ARDS receiving ECMO in our study, 320 had obesity. Of those, 24.1% died in the ICU, compared with 35.3% of patients without obesity (P < 0.001). In adjusted models, obesity was associated with lower ICU mortality (odds ratio, 0.63 [95% confidence interval, 0.43-0.93]; P = 0.018). Examined as a continuous variable, higher body mass index was associated with decreased ICU mortality in multivariable regression (odds ratio, 0.97 [95% confidence interval, 0.95-1.00]; P = 0.023). In propensity score matching of 199 patients with obesity to 199 patients without, patients with obesity had a lower probability of ICU death than those without (22.6% vs. 35.2%; P = 0.007). Conclusions: Among patients receiving ECMO for ARDS, those with obesity had lower ICU mortality than patients without obesity in multivariable and propensity score matching analyses. Our findings support the notion that obesity should not be considered a general contraindication to ECMO.

Keywords: acute respiratory distress syndrome; extracorporeal membrane oxygenation; obesity.

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Figures

Figure 1.
Figure 1.
Forest plot based on the results of multivariable analysis of the factors associated with ICU death in patients with obesity compared with those without obesity. Protective associations are shown in blue, harmful associations in red, and nonsignificant associations in black. CI = confidence interval; ECMO = extracorporeal membrane oxygenation; iNO = inhaled nitric oxide; NMBA = neuromuscular blocking agent; OR = odds ratio; PEEP = positive end-expiratory pressure; PF = PaO2:FiO2.
Figure 2.
Figure 2.
(A and B) Odds ratios of mortality by BMI, unadjusted (A) and adjusted for age, sex, days of invasive mechanical ventilation before cannulation, precannulation positive end-expiratory pressure, pH, PaO2:FiO2, use of neuromuscular blocking agents, inhaled nitric oxide, prone positioning, and renal replacement therapy (B). The continuous association of BMI and odds of ICU death may differ somewhat from the primary model, as it is based on a generalized additive model that smooths the line segments to allow curved transitions over the ranges of BMI values. The solid line represents the estimated odds ratio. The dashed lines represent 95% confidence bands. BMI = body mass index.
Figure 3.
Figure 3.
Kaplan-Meier graph for propensity score–matched populations. BMI = body mass index.
See this image and copyright information in PMC

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