Heart, Lung and Circulation

Impact of Obesity on In-Hospital Outcomes in Veno-Arterial ECMO Patients

Published:August 01, 2022DOI:


      Obesity is known to impact outcomes of patients undergoing in-patient care in general. The association between veno-arterial extracorporeal membrane oxygenation (VA ECMO) and obesity-related outcomes remains unclear. Therefore, we sought to investigate weight-associated differences of patients treated with VA ECMO.


      A retrospective study was performed for patients who required veno-arterial (VA) ECMO support at our tertiary ECMO centre between 1 March 2006 and 28 February 2017. Patients were categorised according to Body-Mass-Index (BMI) associated values in six groups (underweight, normal range, overweight, obese class I-III). Further, patients were divided into non-obese (18.5-29-9 kg/m2) and obese (≥30 kg/m2) groups and analysed concerning baseline, ECMO-related, and general outcome parameters.


      A total of 244 patients required VA ECMO support during the study period. Subgroup-analysis of BMI-category associated impact on in-hospital mortality showed the highest incidence of mortality in obese class II patients (93%) with a significant difference between overweighted patients. Non-obesity was present in 179, whereas 59 patients suffered obesity. Obese patients were significantly older (p=0.022) and suffered significantly more diabetes (21% non-obese vs 48% obese; p<0.001). Indication for support, laboratory parameters prior to ECMO, and ECMO-related outcomes did not differ between the groups. Obese patients showed a trend towards higher in-hospital mortality (70% non-obese vs 81% obese; p=0.085).


      Obesity is associated with comparable outcomes to non-obese patients, showing a tendency of higher mortality. Obese class II patients presented the highest risk of death compared to all BMI categories.


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        • Pozzi M.
        • Flagiello M.
        • Armoiry X.
        • Generali T.
        • Adamou Nouhou K.
        • Koffel C.
        • et al.
        Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction.
        Catheter Cardiovasc Interv. 2020; 95: E71-E77
        • Hogue Jr., C.W.
        • Stearns J.D.
        • Colantuoni E.
        • Robinson K.A.
        • Stierer T.
        • Mitter N.
        • et al.
        The impact of obesity on outcomes after critical illness: a meta-analysis.
        Intensive Care Med. 2009; 35: 1152-1170
        • Anderson M.R.
        • Shashaty M.G.S.
        Impact of obesity in critical illness.
        Chest. 2021; 160: 2135-2145
        • Christian-Miller N.
        • Hadaya J.
        • Nakhla M.
        • Sanaiha Y.
        • Madrigal J.
        • Emami S.
        • et al.
        The impact of obesity on outcomes in patients receiving extracorporeal life support.
        Artif Organs. 2020; 44: 1184-1191
        • Sreenivasan J.
        • Khan M.S.
        • Sharedalal P.
        • Hooda U.
        • Fudim M.
        • Demmer R.T.
        • et al.
        Obesity and outcomes following cardiogenic shock requiring acute mechanical circulatory support.
        Circ Heart Fail. 2021; 14e007937
        • Yumuk V.
        • Tsigos C.
        • Fried M.
        • Schindler K.
        • Busetto L.
        • Micic D.
        • et al.
        European guidelines for obesity management in adults.
        Obes Facts. 2015; 8: 402-424
        • (ELSO) ELSO
        Guidelines for Adult Cardiac Failure.
        Extracorporeal Life Support Organization (ELSO), 2013
        • Ng M.
        • Fleming T.
        • Robinson M.
        • Thomson B.
        • Graetz N.
        • Margono C.
        • et al.
        Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013.
        Lancet. 2014; 384: 766-781
        • Balcova J.
        • Nagaraj N.G.
        • Maggiorini M.
        • Albrecht R.
        • Wilhelm M.J.
        • Maisano F.
        • et al.
        First report about a successful ECLS implantation and subsequent helicopter transfer of a super obese patient with a BMI of 78 kg/m(2).
        Gen Thorac Cardiovasc Surg. 2020; 68: 1506-1508
        • Salna M.
        • Chicotka S.
        • Biscotti 3rd, M.
        • Agerstrand C.
        • Liou P.
        • Brodie D.
        • et al.
        Morbid obesity is not a contraindication to transport on extracorporeal support.
        Eur J Cardiothorac Surg. 2018; 53: 793-798
        • Kandori K.
        • Narumiya H.
        • Iiduka R.
        Drastic drop in blood flow of extracorporeal membrane oxygenation induced by an excessive increase in intra-abdominal pressure in an obese patient.
        Clin Case Rep. 2019; 7: 1945-1947
        • Verkerk B.S.
        • Dzierba A.L.
        • Muir J.
        • Der-Nigoghossian C.
        • Brodie D.
        • Bacchetta M.
        • et al.
        Opioid and benzodiazepine requirements in obese adult patients receiving extracorporeal membrane oxygenation.
        Ann Pharmacother. 2020; 54: 144-150
        • Lu S.Y.
        • Ortoleva J.
        • Colon K.
        • Mueller A.
        • Laflam A.
        • Shelton K.
        • et al.
        Association between body mass index and outcomes in venoarterial extracorporeal membrane oxygenation.
        Anesth Analg. 2022; 134: 341-347
        • Girard L.
        • Djemili F.
        • Devineau M.
        • Gonzalez C.
        • Puech B.
        • Valance D.
        • et al.
        Effect of body mass index on the clinical outcomes of adult patients treated with venoarterial ECMO for cardiogenic shock.
        J Cardiothorac Vasc Anesth. 2021; S1053-0770 (00978-2)
        • Salna M.
        • Fried J.
        • Kaku Y.
        • Brodie D.
        • Sayer G.
        • Uriel N.
        • et al.
        Obesity is not a contraindication to veno-arterial extracorporeal life support.
        Eur J Cardiothorac Surg. 2021; 60: 831-838
        • Zaidi S.A.A.
        • Saleem K.
        Obesity as a risk factor for failure to wean from ECMO: a systematic review and meta-analysis.
        Can Respir J. 2021; 2021: 9967357
        • Daviet F.
        • Guilloux P.
        • Hraiech S.
        • Tonon D.
        • Velly L.
        • Bourenne J.
        • et al.
        Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort.
        Ann Intensive Care. 2021; 11: 157
        • Donini L.M.
        • Pinto A.
        • Giusti A.M.
        • Lenzi A.
        • Poggiogalle E.
        Obesity or BMI paradox? Beneath the tip of the iceberg.
        Front Nutr. 2020; 7: 53
        • Li C.
        • Han D.
        • Xu F.
        • Zheng S.
        • Zhang L.
        • Wang Z.
        • et al.
        Obesity paradox of all-cause mortality in 4,133 patients treated with coronary revascularization.
        J Interv Cardiol. 2021; 2021: 3867735
        • El-Andari R.
        • Bozso S.J.
        • Kang J.J.H.
        • Bedard A.M.A.
        • Adams C.
        • Wang W.
        • et al.
        Heart valve surgery and the obesity paradox: A systematic review.
        Clin Obes. 2021; e12506
        • Cho W.H.
        • Oh J.Y.
        • Yeo H.J.
        • Han J.
        • Kim J.
        • Hong S.B.
        • et al.
        Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: Analysis of the national registry.
        J Crit Care. 2018; 48: 453-457