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Published on: January 17, 2025
Body Mass Index and Survival in Children Receiving Extracorporeal Membrane Oxygenation
Pilar Anton-Martin1, Keith Baxelbaum2, Shilpa Vellore3
1Department of Pediatrics, Division of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Children with underweight or obesity undergoing extracorporeal membrane oxygenation (ECMO) have higher mortality rates. Nutritional status significantly impacts pediatric ECMO outcomes, highlighting the need for further research.
Area of Science:
- Pediatric critical care medicine
- Nutritional science
- Cardiopulmonary support
Background:
- Underweight and obesity pose significant risks to pediatric health globally.
- Both underweight and obesity are linked to increased mortality in children requiring extracorporeal membrane oxygenation (ECMO).
Purpose of the Study:
- To examine the relationship between body mass index (BMI) z-scores and outcomes in pediatric patients receiving ECMO.
- To determine if underweight or obesity status affects survival rates in children on ECMO.
Main Methods:
- Retrospective cohort analysis of the Extracorporeal Life Support Organization (ELSO) database (2019-2023).
- Included pediatric patients (29 days to 18 years) receiving their first ECMO run.
- Analyzed BMI or weight-for-length data against survival to hospital discharge.
Main Results:
- Over 8,800 children were analyzed; 16.4% were underweight and 11.1% were obese.
- Hospital survival was significantly lower for underweight (58.2%) and obese (57.4%) children compared to normal weight (62.4%).
- Underweight (OR 1.34) and obesity (OR 1.25) were associated with increased hospital mortality in multivariable logistic regression.
Conclusions:
- Approximately 25% of pediatric ECMO patients had abnormal BMI, associated with increased mortality.
- Nutritional status is a critical factor influencing clinical outcomes in pediatric ECMO.
- Further prospective research is needed to fully understand the impact of nutritional status on pediatric ECMO outcomes.
Importance:
Underweight and obesity represent opposite ends of the nutritional risk spectrum that negatively affect children's health worldwide. Both conditions have been associated with increased mortality in pediatric patients receiving extracorporeal membrane oxygenation (ECMO) support.
Objective:
To investigate the association of underweight and obesity status with pediatric ECMO outcomes using body mass index (BMI) z scores.
Design, Setting, And Participants:
This retrospective cohort analysis used data from the Extracorporeal Life Support Organization (ELSO) database from January 1, 2019, to December 31, 2023. Participants included all pediatric patients from international ECMO centers aged 29 days to 18 years who received ECMO support during the study period. Data were analyzed from July 1, 2024 to June 30, 2025.
Exposure:
BMI or weight for length.
Main Outcomes And Measures:
Survival to hospital discharge.
Results:
A total of 8885 children undergoing their first ECMO run during the study period were included. The median age was 1.9 years (IQR, 0.4-10.7 years), the median weight was 11 kg (IQR, 6-36 kg), and 4773 patients (53.7%) were male. Among the cohort, 6443 patients (72.5%) had a normal weight (z scores -2 to 2), 1458 (16.4%) had underweight (z score <-2), and 984 (11.1%) had obesity (z score >2). Overall hospital survival occurred in 5453 patients (61.2%) but was significantly lower in patients with underweight (849 [58.2%]) and obesity (565 [57.4%]) compared with normal weight (4020 [62.4%]; P < .001). In multivariable logistic regression, having underweight (odds ratio [OR], 1.34; 95% CI, 1.09-1.66; P = .005) and obesity (OR, 1.25; 95% CI, 1.00-1.56; P = .04) were associated with increased hospital mortality. This pattern persisted across subgroup analyses based on age and diagnosis leading to ECMO cannulation. Severe obesity (BMI z score >3) was not associated with mortality.
Conclusions And Relevance:
In this cohort study of children receiving ECMO, 1 in 4 had an abnormal BMI, which was associated with increased hospital mortality. Prospective studies are warranted to further elucidate and define the association of nutritional status and clinical outcomes in this population.
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