Skip to main content
Top
Published in: BMC Pulmonary Medicine 1/2024

Open Access 01-12-2024 | ECMO | Research

Impact of obesity on outcomes of extracorporeal membrane oxygenation support: a systematic review and meta-analysis

Authors: Xinhua Huang, Xiaoqing Lin

Published in: BMC Pulmonary Medicine | Issue 1/2024

Login to get access

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is used when standard methods of standard treatment methods are not successful. Obese patients present unique challenges during ECMO due to large body size hindering sufficient flows, difficulties with patient positioning and anatomical landmark identification, and restricted radiology scans. This meta-analysis aims to investigate the impact of obesity on the outcomes of patients undergoing ECMO.

Methods

Databases (PubMed, Embase, and Scopus databases) were searched to identify relevant studies published until July 2023. Data were reported as odds ratios (OR) with 95% confidence interval (CI), and the descriptive data were reported as standard difference of means (SDM) by a random effects model.

Results

A literature search identified 345 studies. Of them, 18 studies met the inclusion criteria. The findings from the meta-analysis revealed no significant association between obesity and survival outcomes after ECMO (odds ratio (OR): 0.91, 95% confidence interval (CI): 0.70–1.17, p: 0.46). Moreover, no comparative significant differences were found between obese and non-obese individuals on the duration of ECMO procedure (standardized mean difference (SMD): 0.07, -0.03–0.17), length of hospital stay (-0.03, -0.19 to 0.12), and duration of ventilation support (-0.10, -0.44 to 0.24).

Conclusion

The meta-analysis findings suggest no significant impact of obesity on the survival outcomes after the ECMO procedure. There was no significant impact of obesity on the duration of ECMO procedures, length of hospital stay, and duration of ventilation support.
Appendix
Available only for authorised users
Literature
1.
go back to reference Nair P, Davies AR, Beca J, Bellomo R, Ellwood D, Forrest P, et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011;37:648–54.CrossRefPubMedPubMedCentral Nair P, Davies AR, Beca J, Bellomo R, Ellwood D, Forrest P, et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med. 2011;37:648–54.CrossRefPubMedPubMedCentral
2.
go back to reference Nordan T, Critsinelis AC, Vest A, Zhang Y, Chen FY, Couper GS, et al. Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates. JTCVS Open. 2022;12:234–54.CrossRefPubMedPubMedCentral Nordan T, Critsinelis AC, Vest A, Zhang Y, Chen FY, Couper GS, et al. Prolonged waitlisting is associated with mortality in extracorporeal membrane oxygenation-supported heart transplantation candidates. JTCVS Open. 2022;12:234–54.CrossRefPubMedPubMedCentral
3.
go back to reference Prasad NR, Elkholey K, Patel NR, Junqueira E, Cohen ES, Whitmore SP. Obesity associated with improved mortality of extracorporeal membrane oxygenation for severe COVID-19 pneumonia. Perfusion. 2023;:2676591231178896. Prasad NR, Elkholey K, Patel NR, Junqueira E, Cohen ES, Whitmore SP. Obesity associated with improved mortality of extracorporeal membrane oxygenation for severe COVID-19 pneumonia. Perfusion. 2023;:2676591231178896.
4.
go back to reference May AL, Freedman D, Sherry B, Blanck HM. Centers for Disease Control and Prevention (CDC). Obesity - United States, 1999–2010. MMWR Suppl. 2013;62:120–8.PubMed May AL, Freedman D, Sherry B, Blanck HM. Centers for Disease Control and Prevention (CDC). Obesity - United States, 1999–2010. MMWR Suppl. 2013;62:120–8.PubMed
5.
go back to reference Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Terenzi P, Cozzolino M, et al. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs. 2017;20:50–6.CrossRefPubMed Lazzeri C, Bonizzoli M, Cianchi G, Batacchi S, Terenzi P, Cozzolino M, et al. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs. 2017;20:50–6.CrossRefPubMed
6.
go back to reference Azouz V, Hill S, Firstenberg M. Extracorporeal membrane oxygenation in Extreme obesity: a Case Report and Review of the literature. Heart Surg Forum. 2018;21:E485–8.CrossRefPubMed Azouz V, Hill S, Firstenberg M. Extracorporeal membrane oxygenation in Extreme obesity: a Case Report and Review of the literature. Heart Surg Forum. 2018;21:E485–8.CrossRefPubMed
7.
go back to reference Diaz RA, Graf J, Zambrano JM, Ruiz C, Espinoza JA, Bravo SI, et al. Extracorporeal membrane oxygenation for COVID-19-associated severe Acute Respiratory Distress Syndrome in Chile: a Nationwide Incidence and Cohort Study. Am J Respir Crit Care Med. 2021;204:34–43.CrossRefPubMedPubMedCentral Diaz RA, Graf J, Zambrano JM, Ruiz C, Espinoza JA, Bravo SI, et al. Extracorporeal membrane oxygenation for COVID-19-associated severe Acute Respiratory Distress Syndrome in Chile: a Nationwide Incidence and Cohort Study. Am J Respir Crit Care Med. 2021;204:34–43.CrossRefPubMedPubMedCentral
8.
go back to reference Powell EK, Haase DJ, Lankford A, Boswell K, Esposito E, Hamera J, et al. Body mass index does not impact survival in COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation. Perfusion. 2023;38:1174–81.CrossRefPubMed Powell EK, Haase DJ, Lankford A, Boswell K, Esposito E, Hamera J, et al. Body mass index does not impact survival in COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation. Perfusion. 2023;38:1174–81.CrossRefPubMed
9.
go back to reference Peetermans M, Guler I, Meersseman P, Wilmer A, Wauters J, Meyns B, et al. Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study. Intensive Care Med. 2023;49:37–49.CrossRefPubMed Peetermans M, Guler I, Meersseman P, Wilmer A, Wauters J, Meyns B, et al. Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study. Intensive Care Med. 2023;49:37–49.CrossRefPubMed
10.
go back to reference Salna M, Chicotka S, Biscotti M, Agerstrand C, Liou P, Brodie D, et al. Morbid obesity is not a contraindication to transport on extracorporeal support. Eur J Cardiothorac Surg. 2018;53:793–8.CrossRefPubMed Salna M, Chicotka S, Biscotti M, Agerstrand C, Liou P, Brodie D, et al. Morbid obesity is not a contraindication to transport on extracorporeal support. Eur J Cardiothorac Surg. 2018;53:793–8.CrossRefPubMed
11.
go back to reference Salna M, Fried J, Kaku Y, Brodie D, Sayer G, Uriel N, et al. Obesity is not a contraindication to veno-arterial extracorporeal life support. Eur J Cardiothorac Surg. 2021;60:831–8.CrossRefPubMed Salna M, Fried J, Kaku Y, Brodie D, Sayer G, Uriel N, et al. Obesity is not a contraindication to veno-arterial extracorporeal life support. Eur J Cardiothorac Surg. 2021;60:831–8.CrossRefPubMed
12.
go back to reference Weinberg A, Tapson VF, Ramzy D. Massive pulmonary embolism: extracorporeal membrane oxygenation and Surgical Pulmonary Embolectomy. Semin Respir Crit Care Med. 2017;38:66–72.CrossRefPubMed Weinberg A, Tapson VF, Ramzy D. Massive pulmonary embolism: extracorporeal membrane oxygenation and Surgical Pulmonary Embolectomy. Semin Respir Crit Care Med. 2017;38:66–72.CrossRefPubMed
13.
go back to reference Kosmopoulos M, Kalra R, Alexy T, Gaisendrees C, Jaeger D, Chahine J, et al. The impact of BMI on arrest characteristics and survival of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Resuscitation. 2023;188:109842.CrossRefPubMed Kosmopoulos M, Kalra R, Alexy T, Gaisendrees C, Jaeger D, Chahine J, et al. The impact of BMI on arrest characteristics and survival of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Resuscitation. 2023;188:109842.CrossRefPubMed
14.
go back to reference Lee SN, Moon D, Jo MS, Yoo K-D. Associations between Body Mass Index and Clinical outcomes in Acute Myocardial Infarction supported with extracorporeal membrane oxygenation. Acta Cardiol Sin. 2020;36:448–55.PubMedPubMedCentral Lee SN, Moon D, Jo MS, Yoo K-D. Associations between Body Mass Index and Clinical outcomes in Acute Myocardial Infarction supported with extracorporeal membrane oxygenation. Acta Cardiol Sin. 2020;36:448–55.PubMedPubMedCentral
15.
go back to reference Merritt-Genore H, Lyden E, Ryan T, Kwapnoski Z. The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency. J Card Surg. 2020;35:1283–6.CrossRefPubMed Merritt-Genore H, Lyden E, Ryan T, Kwapnoski Z. The effect of patient obesity on extracorporeal membrane oxygenator outcomes and ventilator dependency. J Card Surg. 2020;35:1283–6.CrossRefPubMed
16.
go back to reference Lu SY, Ortoleva J, Colon K, Mueller A, Laflam A, Shelton K, et al. Association between Body Mass Index and outcomes in Venoarterial extracorporeal membrane oxygenation. Anesth Analg. 2022;134:341–7.CrossRefPubMed Lu SY, Ortoleva J, Colon K, Mueller A, Laflam A, Shelton K, et al. Association between Body Mass Index and outcomes in Venoarterial extracorporeal membrane oxygenation. Anesth Analg. 2022;134:341–7.CrossRefPubMed
17.
go back to reference Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.CrossRefPubMedPubMedCentral Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.CrossRefPubMedPubMedCentral
18.
go back to reference Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.CrossRefPubMedPubMedCentral Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.CrossRefPubMedPubMedCentral
19.
go back to reference Borenstein M. Comprehensive Meta-Analysis Software. 2022. p. 535–48. Borenstein M. Comprehensive Meta-Analysis Software. 2022. p. 535–48.
20.
go back to reference Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.CrossRefPubMed Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.CrossRefPubMed
21.
go back to reference Duval S, Tweedie R. A nonparametric Trim and fill Method of Accounting for Publication Bias in Meta-Analysis. J Am Stat Assoc. 2000;95:89–98. Duval S, Tweedie R. A nonparametric Trim and fill Method of Accounting for Publication Bias in Meta-Analysis. J Am Stat Assoc. 2000;95:89–98.
22.
go back to reference Kon ZN, Dahi S, Evans CF, Byrnes KA, Bittle GJ, Wehman B, et al. Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support. Ann Thorac Surg. 2015;100:1855–60.CrossRefPubMed Kon ZN, Dahi S, Evans CF, Byrnes KA, Bittle GJ, Wehman B, et al. Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support. Ann Thorac Surg. 2015;100:1855–60.CrossRefPubMed
23.
go back to reference Cho WH, Oh JY, Yeo HJ, Han J, Kim J, Hong S-B, et al. Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: analysis of the national registry. J Crit Care. 2018;48:453–7.CrossRefPubMed Cho WH, Oh JY, Yeo HJ, Han J, Kim J, Hong S-B, et al. Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: analysis of the national registry. J Crit Care. 2018;48:453–7.CrossRefPubMed
24.
go back to reference Galvagno SM, Pelekhaty S, Cornachione CR, Deatrick KB, Mazzeffi MA, Scalea TM, et al. Does Weight Matter? Outcomes in adult patients on venovenous extracorporeal membrane oxygenation when stratified by obesity class. Anesth Analg. 2020;131:754–61.CrossRefPubMed Galvagno SM, Pelekhaty S, Cornachione CR, Deatrick KB, Mazzeffi MA, Scalea TM, et al. Does Weight Matter? Outcomes in adult patients on venovenous extracorporeal membrane oxygenation when stratified by obesity class. Anesth Analg. 2020;131:754–61.CrossRefPubMed
25.
go back to reference Verkerk BS, Dzierba AL, Muir J, Der-Nigoghossian C, Brodie D, Bacchetta M, et al. Opioid and benzodiazepine requirements in obese adult patients receiving extracorporeal membrane oxygenation. Ann Pharmacother. 2020;54:144–50.CrossRefPubMed Verkerk BS, Dzierba AL, Muir J, Der-Nigoghossian C, Brodie D, Bacchetta M, et al. Opioid and benzodiazepine requirements in obese adult patients receiving extracorporeal membrane oxygenation. Ann Pharmacother. 2020;54:144–50.CrossRefPubMed
26.
go back to reference Alvarez NH, O’Malley TJ, Abai B, Salvatore DM, DiMuzio PJ, Hirose H. Complications of Peripheral Cannulation Site in obese patients on adult extracorporeal membrane oxygenation. ASAIO J. 2021;67:1294–300.CrossRefPubMed Alvarez NH, O’Malley TJ, Abai B, Salvatore DM, DiMuzio PJ, Hirose H. Complications of Peripheral Cannulation Site in obese patients on adult extracorporeal membrane oxygenation. ASAIO J. 2021;67:1294–300.CrossRefPubMed
27.
go back to reference Mongero LB, Stammers AH, Tesdahl EA, Petersen C, Patel K, Jacobs JP. The use of extracorporeal membrane oxygenation in COVID-19 patients with severe cardiorespiratory failure: the influence of obesity on outcomes. J Extra Corpor Technol. 2021;53:293–8.CrossRefPubMedPubMedCentral Mongero LB, Stammers AH, Tesdahl EA, Petersen C, Patel K, Jacobs JP. The use of extracorporeal membrane oxygenation in COVID-19 patients with severe cardiorespiratory failure: the influence of obesity on outcomes. J Extra Corpor Technol. 2021;53:293–8.CrossRefPubMedPubMedCentral
28.
go back to reference Balik M, Svobodova E, Porizka M, Maly M, Brestovansky P, Volny L, et al. The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox. J Crit Care. 2022;72:154162.CrossRefPubMedPubMedCentral Balik M, Svobodova E, Porizka M, Maly M, Brestovansky P, Volny L, et al. The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox. J Crit Care. 2022;72:154162.CrossRefPubMedPubMedCentral
29.
go back to reference Djordjevic I, Ivanov B, Sabashnikov A, Gaisendrees C, Gerfer S, Suhr L, et al. Impact of obesity on In-Hospital outcomes in veno-arterial ECMO patients. Heart Lung Circ. 2022;31:1393–8.CrossRefPubMed Djordjevic I, Ivanov B, Sabashnikov A, Gaisendrees C, Gerfer S, Suhr L, et al. Impact of obesity on In-Hospital outcomes in veno-arterial ECMO patients. Heart Lung Circ. 2022;31:1393–8.CrossRefPubMed
30.
go back to reference Javidfar J, Zaaqoq AM, Labib A, Barnett AG, Hayanga JA, Eschun G et al. Morbid obesity’s impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: the covid-19 critical care consortium database review. Perfusion. 2023;:2676591231156487. Javidfar J, Zaaqoq AM, Labib A, Barnett AG, Hayanga JA, Eschun G et al. Morbid obesity’s impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: the covid-19 critical care consortium database review. Perfusion. 2023;:2676591231156487.
31.
go back to reference Heuts S, Mariani S, van Bussel BCT, Boeken U, Samalavicius R, Bounader K, et al. The relation between obesity and mortality in Postcardiotomy Venoarterial membrane oxygenation. Ann Thorac Surg. 2023;116:147–54.CrossRefPubMed Heuts S, Mariani S, van Bussel BCT, Boeken U, Samalavicius R, Bounader K, et al. The relation between obesity and mortality in Postcardiotomy Venoarterial membrane oxygenation. Ann Thorac Surg. 2023;116:147–54.CrossRefPubMed
33.
go back to reference Spinelli E, Colussi G, Dal Santo G, Scotti E, Marongiu I, Garbelli E, et al. Atelectasis, Shunt, and worsening oxygenation following reduction of respiratory rate in healthy pigs undergoing ECMO: an experimental lung imaging study. Front Physiol. 2021;12:663313.CrossRefPubMedPubMedCentral Spinelli E, Colussi G, Dal Santo G, Scotti E, Marongiu I, Garbelli E, et al. Atelectasis, Shunt, and worsening oxygenation following reduction of respiratory rate in healthy pigs undergoing ECMO: an experimental lung imaging study. Front Physiol. 2021;12:663313.CrossRefPubMedPubMedCentral
34.
36.
go back to reference Chait A, den Hartigh LJ. Adipose tissue distribution, inflammation and its metabolic consequences, including Diabetes and Cardiovascular Disease. Front Cardiovasc Med. 2020;7:22.CrossRefPubMedPubMedCentral Chait A, den Hartigh LJ. Adipose tissue distribution, inflammation and its metabolic consequences, including Diabetes and Cardiovascular Disease. Front Cardiovasc Med. 2020;7:22.CrossRefPubMedPubMedCentral
37.
go back to reference Ghigliotti G, Barisione C, Garibaldi S, Fabbi P, Brunelli C, Spallarossa P, et al. Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions. Inflammation. 2014;37:1337–53.CrossRefPubMed Ghigliotti G, Barisione C, Garibaldi S, Fabbi P, Brunelli C, Spallarossa P, et al. Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions. Inflammation. 2014;37:1337–53.CrossRefPubMed
Metadata
Title
Impact of obesity on outcomes of extracorporeal membrane oxygenation support: a systematic review and meta-analysis
Authors
Xinhua Huang
Xiaoqing Lin
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2024
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/s12890-024-02971-5

Other articles of this Issue 1/2024

BMC Pulmonary Medicine 1/2024 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine