ECMO for patients with obesity: evidence and practice

Area of Science:

• Critical Care Medicine
• Cardiopulmonary Support
• Obesity Medicine

Background:

• Obesity is a growing concern in patients needing extracorporeal membrane oxygenation (ECMO).
• Obesity impacts physiology, drug pharmacokinetics, and presents technical challenges in ECMO management.
• This review examines obesity's role in veno-venous (VV) and veno-arterial (VA) ECMO.

Purpose of the Study:

• To review the epidemiology of obesity in ECMO patients.
• To discuss the physiological implications of obesity during ECMO.
• To summarize outcomes and management strategies for obese patients on ECMO.

Main Methods:

• Literature review of current evidence.
• Analysis of retrospective data based on body mass index.
• Synthesis of information on VV-ECMO and VA-ECMO outcomes.

Main Results:

• Obesity is not a contraindication for VV-ECMO, with comparable or better outcomes than non-obese patients.
• Obesity may worsen apparent lung injury severity, necessitating optimized ARDS management before VV-ECMO.
• VA-ECMO outcomes in obese patients are heterogeneous, influenced by patient selection and comorbidities.

Conclusions:

• Obesity should not prevent ECMO access, particularly VV-ECMO.
• Successful ECMO in obese patients requires anticipating challenges and using multidisciplinary protocols.
• Further research is needed to optimize management and evaluate long-term outcomes.