Impact of body mass index (BMI) on outcomes in respiratory extracorporeal membrane oxygenation (ECMO): an Extracorporeal Life Support Organization (ELSO) registry study
Authors' conclusion
Patients with obesity class II or more treated with ECMO for respiratory failure have lower mortality risk and shorter stays, despite increased cardiovascular, device-related, and renal complications. No upper limit of BMI indicating futility of ECMO treatment could be identified.
Study context
- Population
- Adults with respiratory failure treated with ECMO, ELSO Registry 2010–2020
- Participants
- 18,529 adults
- Exposure
- BMI ≥ 35 kg/m² vs lower BMI
- Outcome
- In-hospital mortality
Methodological detailsregistry analysis, propensity-score matched, inverse propensity-score weighted, multivariable models
- Registry analysis
- Propensity-score matched
- Inverse propensity-score weighted
- Multivariable models
Main finding
As reported in the abstract
BMI ≥ 35 kg/m² vs LeanOdds ratio (95% CI)P value
PS-matched
0.878(0.798–0.966)
P = 0.008IPSW
0.899(0.827–0.979)
P = 0.014MV
0.900(0.834–0.971)
P = 0.007Observational data: associations, not effects.
Further findings
Hospital LOS
- Shorter hospital LOS with BMI ≥ 35 kg/m²
Form of BMI–outcome relationship
- Non-linear relationship; no cutoff for futility identified
Safety
- Cardiovascular complications, BMI ≥ 35 kg/m² vs lean
- 17.3% versus 15.3%
- Renal complications, BMI ≥ 35 kg/m² vs lean
- 37% versus 30%
- Device-related complications, BMI ≥ 35 kg/m² vs lean
- 25.7% versus 20.6%
- Pulmonary complications, BMI ≥ 35 kg/m² vs lean
- 7.6% versus 9.3%
- Independent of confounders in propensity-score (PS)-matched, inverse propensity-score weighted (IPSW) and MV models
Original publication
Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study. Intensive Care Med. Published 22 November 2022. doi:10.
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