Outcome of Veno-Venous Extracorporeal Membrane Oxygenation in Obese COVID-19 Patients Is Not Inferior to Normal Weight Patients

Background: Since late 2019, infections with novel coronavirus SARS-CoV-2 have caused a global pandemic. By now, limited adequate pharmacological therapy exists for severe COVID-19 related acute respiratory distress syndrome (ARDS). Therefore, treatment with veno-venous extracorporeal membrane oxygenation (vv-ECMO) still is considered as an ultimate rescue option. However, especially in obese patients, implantation of vv-EMCO cannulas is challenging and results in these patients are often considered as inferior to normal weight control patients.

Method: Between 2020 and 2022, a total of 82 patients were treated with vv-ECMO for severe COVID-19-related ARDS in our department. All patients were prospectively enrolled into an institutional database and retrospectively reviewed for the purpose of this study. Patients were divided concerning their body mass index (BMI) (BMI ≤ 30.0 kg/m²: control, n = 41; BMI > 30.0 kg/m²: obesity, n = 41).

Results: Mean BMI of the control group was 27.0 ± 2.1 kg/m² compared with 33.5 ± 5.3 kg/m² in obesity group (p < 0.01). Minimum BMI of the whole cohort was 23.0 kg/m² and maximum BMI 50.0 kg/m². There were no relevant differences regarding age, gender and the incidence of concomitant diseases, except for diabetes (control: 17.1%, obesity: 41.5%, p = 0.03) and renal insufficiency (control: 22.0%, obesity: 4.9%, p = 0.05) between the two study groups. Peri-interventional incidence of severe device-related adverse events such as bleeding (control: 17.1%, obesity: 25.0%, p = 0.42), ischemic stroke (control: 9.8%, obesity: 10.0%, p > 0.99), intracranial bleeding (control: 22.0%, obesity: 27.5%, p = 0.61), and visceral ischemia (control: 4.9%, obesity: 12.2%, p = 0.43) did not differ with regard to the BMI. Weaning from vv-ECMO was achieved in 39.0% of the obese patients and in 34.0% of the controls (p = 0.82). In-hospital death was observed for 75.6% of the control patients compared with 61.0% for the obesity group (p = 0.24).

Conclusion: vv-ECMO as ultimate rescue therapy for serve COVID-19-related ARDS is also feasible in obese patients. Although implantation of the cannulas may be more difficult in obese patients, the results regarding weaning rate and survival are encouraging and not inferior to non-obese patients. However, an increased rate of kidney injury in the control group during vv-ECMO support may represent a relevant confounder, which should be investigated in larger study cohorts.

Publication History

Article published online:
28 January 2023