• Darya Rudym, Tài Pham, Craig R Rackley, Giacomo Grasselli, Michaela Anderson, Matthew R Baldwin, Jeremy Beitler, Cara Agerstrand, Alexis Serra, Lisle A Winston, Desiree Bonadonna, Natalie Yip, Logan J Emerson, Amy Dzierba, Joshua Sonett, Darryl Abrams, Niall D Ferguson, Matthew Bacchetta, Matthieu Schmidt, Daniel Brodie, and LIFEGARDS collaborators.
• Department of Medicine, New York University Langone Health, New York, New York.
• Am. J. Respir. Crit. Care Med. 2023 Sep 15; 208 (6): 685694685-694.

AbstractRationale: 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.

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