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(727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia

PURPOSE: Morbidly obese patients are considered to be poor candidates for extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID-19 pneumonia. A body mass index (BMI) greater than or equal to 40 is a relative contraindication to ECMO by the Extracorporeal Life S...

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Autores principales: Prasad, N., Elkholey, K., Junqueira, E., Cohen, E., Whitmore, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Published by Elsevier Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068087/
http://dx.doi.org/10.1016/j.healun.2023.02.741
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author Prasad, N.
Elkholey, K.
Junqueira, E.
Cohen, E.
Whitmore, S.
author_facet Prasad, N.
Elkholey, K.
Junqueira, E.
Cohen, E.
Whitmore, S.
author_sort Prasad, N.
collection PubMed
description PURPOSE: Morbidly obese patients are considered to be poor candidates for extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID-19 pneumonia. A body mass index (BMI) greater than or equal to 40 is a relative contraindication to ECMO by the Extracorporeal Life Support Organization (ELSO) COVID-19 guidelines. This study seeks to determine the impact of obesity on survival of patients with COVID-19 on ECMO. METHODS: This project is a retrospective cohort study of a multicenter US healthcare system queried from January 2020 to December 2021. All patients aged 16 years and older with COVID-19 treated with ECMO support were included in the study. Patients with missing data on ECMO duration were excluded from secondary analyses. The primary outcome was in-hospital mortality in a time-to-event analysis after ECMO initiation, with a comparison between patient groups based on body mass index (BMI) categories. Secondary outcomes included ventilator days, intensive care days, complications, and discharge destination. RESULTS: We identified 335 patients for the primary analysis; 66 were removed from secondary analysis due to missing data for duration of ECMO. There were no baseline differences between obese and non-obese patients in terms of demographics, comorbidities, pre-ECMO treatments, or hospital length of stay. Obese patients were more likely to be younger (median age 41 vs 45; p = 0.016). Obesity (BMI ≥ 30) was associated with a decreased risk of mortality, odds ratio 0.620 (95% CI 0.399 - 0.964; p = 0.0338) after controlling for age. Severe obesity (BMI ≥ 40) was not associated with increased mortality compared to non-obese. Secondary analysis of 269 patients with complete data demonstrate overall in-hospital mortality of 34.3%. There was no difference in ECMO duration, ICU length of stay, rate of blood stream infection, stroke, or blood transfusion between BMI groups. CONCLUSION: Obesity is not associated with increased mortality on ECMO for COVID-19. Neither obesity nor severe obesity should be used to rule out candidacy for the use of ECMO in this population.
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spelling pubmed-100680872023-04-03 (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia Prasad, N. Elkholey, K. Junqueira, E. Cohen, E. Whitmore, S. J Heart Lung Transplant Article PURPOSE: Morbidly obese patients are considered to be poor candidates for extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID-19 pneumonia. A body mass index (BMI) greater than or equal to 40 is a relative contraindication to ECMO by the Extracorporeal Life Support Organization (ELSO) COVID-19 guidelines. This study seeks to determine the impact of obesity on survival of patients with COVID-19 on ECMO. METHODS: This project is a retrospective cohort study of a multicenter US healthcare system queried from January 2020 to December 2021. All patients aged 16 years and older with COVID-19 treated with ECMO support were included in the study. Patients with missing data on ECMO duration were excluded from secondary analyses. The primary outcome was in-hospital mortality in a time-to-event analysis after ECMO initiation, with a comparison between patient groups based on body mass index (BMI) categories. Secondary outcomes included ventilator days, intensive care days, complications, and discharge destination. RESULTS: We identified 335 patients for the primary analysis; 66 were removed from secondary analysis due to missing data for duration of ECMO. There were no baseline differences between obese and non-obese patients in terms of demographics, comorbidities, pre-ECMO treatments, or hospital length of stay. Obese patients were more likely to be younger (median age 41 vs 45; p = 0.016). Obesity (BMI ≥ 30) was associated with a decreased risk of mortality, odds ratio 0.620 (95% CI 0.399 - 0.964; p = 0.0338) after controlling for age. Severe obesity (BMI ≥ 40) was not associated with increased mortality compared to non-obese. Secondary analysis of 269 patients with complete data demonstrate overall in-hospital mortality of 34.3%. There was no difference in ECMO duration, ICU length of stay, rate of blood stream infection, stroke, or blood transfusion between BMI groups. CONCLUSION: Obesity is not associated with increased mortality on ECMO for COVID-19. Neither obesity nor severe obesity should be used to rule out candidacy for the use of ECMO in this population. Published by Elsevier Inc. 2023-04 2023-04-03 /pmc/articles/PMC10068087/ http://dx.doi.org/10.1016/j.healun.2023.02.741 Text en Copyright © 2023 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Prasad, N.
Elkholey, K.
Junqueira, E.
Cohen, E.
Whitmore, S.
(727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title_full (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title_fullStr (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title_full_unstemmed (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title_short (727) Obesity is Associated with Improved Outcome of Extracorporeal Membrane Oxygenation for Severe Covid-19 Pneumonia
title_sort (727) obesity is associated with improved outcome of extracorporeal membrane oxygenation for severe covid-19 pneumonia
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10068087/
http://dx.doi.org/10.1016/j.healun.2023.02.741
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