Samuel M Galvagno1,2, Stacy Pelekhaty2,3, Christopher R Cornachione4, Kristopher B Deatrick5, Michael A Mazzeffi1, Thomas M Scalea2,3, Jay Menaker2,3,6. 1. From the Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland. 2. Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. 3. University of Maryland School of Medicine, Baltimore, Maryland. 4. Lung Rescue Unit, Program in Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland. 5. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 6. Critical Care Resuscitation Unit and Lung Rescue Unit, Baltimore, Maryland.
Abstract
BACKGROUND: Many believe obesity is associated with higher rates of mortality in the critically ill. The purpose of this retrospective observational study is to evaluate the association between body mass index (BMI) and survival in patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) for acute hypoxic or hypercarbic respiratory failure. METHODS: All of the patients admitted to a dedicated VV ECMO unit were included. Patients <18 years of age, listed for lung transplant, or underweight were excluded. ECMO outcomes, including hospital length of stay and survival to discharge, were analyzed after stratification according to BMI. Multivariate logistic and linear regression techniques were used to assess variables associated with the outcomes of death and length of stay, respectively. RESULTS: One hundred ninety-four patients with a median BMI of 35.7 kg/m (33-42 kg/m) were included. Obese patients were older, had higher creatinine levels, and required higher levels of positive end-expiratory pressure and mean airway pressure at time of cannulation. Survival to discharge in any group did not differ when stratified by BMI classification (P = .36). Multivariable regression did not reveal any association with greater odds of death or longer length of stay when controlling for BMI and other variables. CONCLUSIONS: We did not detect an association between obesity and increased mortality in patients requiring VV ECMO for acute hypoxic or hypercarbic respiratory failure. These data suggest that obesity alone should not exclude candidacy for VV ECMO. Evidence for the "obesity paradox" in this population of VV ECMO patients may be supported by these data.
BACKGROUND: Many believe obesity is associated with higher rates of mortality in the critically ill. The purpose of this retrospective observational study is to evaluate the association between body mass index (BMI) and survival in patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) for acute hypoxic or hypercarbic respiratory failure. METHODS: All of the patients admitted to a dedicated VV ECMO unit were included. Patients <18 years of age, listed for lung transplant, or underweight were excluded. ECMO outcomes, including hospital length of stay and survival to discharge, were analyzed after stratification according to BMI. Multivariate logistic and linear regression techniques were used to assess variables associated with the outcomes of death and length of stay, respectively. RESULTS: One hundred ninety-four patients with a median BMI of 35.7 kg/m (33-42 kg/m) were included. Obesepatients were older, had higher creatinine levels, and required higher levels of positive end-expiratory pressure and mean airway pressure at time of cannulation. Survival to discharge in any group did not differ when stratified by BMI classification (P = .36). Multivariable regression did not reveal any association with greater odds of death or longer length of stay when controlling for BMI and other variables. CONCLUSIONS: We did not detect an association between obesity and increased mortality in patients requiring VV ECMO for acute hypoxic or hypercarbic respiratory failure. These data suggest that obesity alone should not exclude candidacy for VV ECMO. Evidence for the "obesity paradox" in this population of VV ECMO patients may be supported by these data.
Authors: Johannes Herrmann; Christopher Lotz; Christian Karagiannidis; Steffen Weber-Carstens; Stefan Kluge; Christian Putensen; Andreas Wehrfritz; Karsten Schmidt; Richard K Ellerkmann; Daniel Oswald; Gösta Lotz; Viviane Zotzmann; Onnen Moerer; Christian Kühn; Matthias Kochanek; Ralf Muellenbach; Matthias Gaertner; Falk Fichtner; Florian Brettner; Michael Findeisen; Markus Heim; Tobias Lahmer; Felix Rosenow; Nils Haake; Philipp M Lepper; Peter Rosenberger; Stephan Braune; Mirjam Kohls; Peter Heuschmann; Patrick Meybohm Journal: Crit Care Date: 2022-06-28 Impact factor: 19.334
Authors: Elizabeth K Powell; Daniel J Haase; Allison Lankford; Kimberly Boswell; Emily Esposito; Joseph Hamera; Siamak Dahi; Eric Krause; Gregory Bittle; Kristopher B Deatrick; Bree Ann C Young; Samuel M Galvagno; Ali Tabatabai Journal: Perfusion Date: 2022-04-25 Impact factor: 1.581
Authors: Francesco Zadek; Jonah Rubin; Luigi Grassi; Daniel Van Den Kroonenberg; Grant Larson; Martin Capriles; Roberta De Santis Santiago; Gaetano Florio; David A Imber; Edward A Bittner; Kathryn A Hibbert; Alex Legassey; Jeliene LaRocque; Gaston Cudemus-Deseda; Aranya Bagchi; Jerome Crowley; Kenneth Shelton; Robert Kacmarek; Lorenzo Berra Journal: Crit Care Explor Date: 2021-06-29
Authors: Mazen Odish; Cassia Yi; Christopher Tainter; Samira Najmaii; Julio Ovando; Laura Chechel; Jerry Lipinski; Alex Ignatyev; Alexander Pile; Yun Yeong Jang; Tuo Lin; Xin M Tu; Michael Madani; Mitul Patel; Angela Meier; Travis Pollema; Robert L Owens Journal: Crit Care Explor Date: 2021-06-15