• Colin G McCloskey, Kevin W Hatton, David Furfaro, and Milo Engoren.
• Harrington Heart and Vascular Institute, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
• Crit. Care Med. 2024 Dec 17.

ObjectivesTo determine the relationship between all-cause hospital mortality and morbidity in patients treated with venoarterial extracorporeal membrane oxygenation (ECMO) and to assess whether this relationship is mediated via body mass index (BMI).DesignUsing the Extracorporeal Life Support Organization (ELSO) registry, venoarterial ECMO runs from 2015 to 2021 were retrospectively analyzed. Patient demographics, ECMO indications, and complications for survivors and decedents were univariately compared. Logistic regression with fractional polynomials was used to estimate the relationship between BMI and both mortality and complications in venoarterial ECMO patients.SettingContributing centers to the ELSO ECMO registry.PatientsPatients that underwent venoarterial ECMO at an ELSO contributing ECMO center.InterventionsNone.Measurements And Main ResultsTwenty-two thousand eight hundred twenty-five venoarterial ECMO runs met inclusion criteria for analysis. The mean BMI for survivors was 28.4 ± 6.5 vs. 29.5 ± 6.9 kg/m2 for decedents. BMI was significantly associated with mortality (p < 0.001), with the proportion of patients dying increasing with increasing BMI: 47% of underweight patients died, increasing to 50% for the normal range, to 53%, 56%, 58%, and 65% for preobese, class 1, class 2, and class 3 obese patients, respectively. Relative to a BMI of 25, a BMI of 35 had an odds ratio (OR) of death of 1.15 (1.09-1.18), and a BMI of 45 an OR of 1.46 (1.25-1.57). BMI was significantly associated with increased mechanical and renal complications, but decreased pulmonary complications.ConclusionsIn patients undergoing venoarterial ECMO, increasing BMI was associated with increasing all-cause mortality and mechanical and renal complications.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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