Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation : The Multicenter ECMObesity Study
Rationale: Patients with obesity are at increased risk for developing acute respiratory distress syndrome (ARDS). Some centers consider obesity a relative contraindication to receiving extracorporeal membrane oxygenation (ECMO) support, despite growing implementation of ECMO for ARDS in the general population. Objectives: To investigate the association between obesity and mortality in patients with ARDS receiving ECMO. Methods: In this large, international, multicenter, retrospective cohort study, we evaluated the association of obesity, defined as body mass index ⩾ 30 kg/m2, with ICU mortality in patients receiving ECMO for ARDS by performing adjusted multivariable logistic regression and propensity score matching. Measurements and Main Results: Of 790 patients with ARDS receiving ECMO in our study, 320 had obesity. Of those, 24.1% died in the ICU, compared with 35.3% of patients without obesity (P < 0.001). In adjusted models, obesity was associated with lower ICU mortality (odds ratio, 0.63 [95% confidence interval, 0.43-0.93]; P = 0.018). Examined as a continuous variable, higher body mass index was associated with decreased ICU mortality in multivariable regression (odds ratio, 0.97 [95% confidence interval, 0.95-1.00]; P = 0.023). In propensity score matching of 199 patients with obesity to 199 patients without, patients with obesity had a lower probability of ICU death than those without (22.6% vs. 35.2%; P = 0.007). Conclusions: Among patients receiving ECMO for ARDS, those with obesity had lower ICU mortality than patients without obesity in multivariable and propensity score matching analyses. Our findings support the notion that obesity should not be considered a general contraindication to ECMO.
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2023 Sep 15;208(6):649-650. - PMID 37638784 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:208 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 208(2023), 6 vom: 15. Sept., Seite 685-694 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rudym, Darya [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory distress syndrome |
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| Anmerkungen: |
Date Completed 18.09.2023 Date Revised 27.02.2024 published: Print CommentIn: Am J Respir Crit Care Med. 2023 Sep 15;208(6):649-650. - PMID 37638784 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.202212-2293OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM36136847X |
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| 100 | 1 | |a Rudym, Darya |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation |b The Multicenter ECMObesity Study |
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| 500 | |a Date Completed 18.09.2023 | ||
| 500 | |a Date Revised 27.02.2024 | ||
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| 500 | |a CommentIn: Am J Respir Crit Care Med. 2023 Sep 15;208(6):649-650. - PMID 37638784 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Patients with obesity are at increased risk for developing acute respiratory distress syndrome (ARDS). Some centers consider obesity a relative contraindication to receiving extracorporeal membrane oxygenation (ECMO) support, despite growing implementation of ECMO for ARDS in the general population. Objectives: To investigate the association between obesity and mortality in patients with ARDS receiving ECMO. Methods: In this large, international, multicenter, retrospective cohort study, we evaluated the association of obesity, defined as body mass index ⩾ 30 kg/m2, with ICU mortality in patients receiving ECMO for ARDS by performing adjusted multivariable logistic regression and propensity score matching. Measurements and Main Results: Of 790 patients with ARDS receiving ECMO in our study, 320 had obesity. Of those, 24.1% died in the ICU, compared with 35.3% of patients without obesity (P < 0.001). In adjusted models, obesity was associated with lower ICU mortality (odds ratio, 0.63 [95% confidence interval, 0.43-0.93]; P = 0.018). Examined as a continuous variable, higher body mass index was associated with decreased ICU mortality in multivariable regression (odds ratio, 0.97 [95% confidence interval, 0.95-1.00]; P = 0.023). In propensity score matching of 199 patients with obesity to 199 patients without, patients with obesity had a lower probability of ICU death than those without (22.6% vs. 35.2%; P = 0.007). Conclusions: Among patients receiving ECMO for ARDS, those with obesity had lower ICU mortality than patients without obesity in multivariable and propensity score matching analyses. Our findings support the notion that obesity should not be considered a general contraindication to ECMO | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a acute respiratory distress syndrome | |
| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 650 | 4 | |a obesity | |
| 700 | 1 | |a Pham, Tài |e verfasserin |4 aut | |
| 700 | 1 | |a Rackley, Craig R |e verfasserin |4 aut | |
| 700 | 1 | |a Grasselli, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, Michaela |e verfasserin |4 aut | |
| 700 | 1 | |a Baldwin, Matthew R |e verfasserin |4 aut | |
| 700 | 1 | |a Beitler, Jeremy |e verfasserin |4 aut | |
| 700 | 1 | |a Agerstrand, Cara |e verfasserin |4 aut | |
| 700 | 1 | |a Serra, Alexis |e verfasserin |4 aut | |
| 700 | 1 | |a Winston, Lisle A |e verfasserin |4 aut | |
| 700 | 1 | |a Bonadonna, Desiree |e verfasserin |4 aut | |
| 700 | 1 | |a Yip, Natalie |e verfasserin |4 aut | |
| 700 | 1 | |a Emerson, Logan J |e verfasserin |4 aut | |
| 700 | 1 | |a Dzierba, Amy |e verfasserin |4 aut | |
| 700 | 1 | |a Sonett, Joshua |e verfasserin |4 aut | |
| 700 | 1 | |a Abrams, Darryl |e verfasserin |4 aut | |
| 700 | 1 | |a Ferguson, Niall D |e verfasserin |4 aut | |
| 700 | 1 | |a Bacchetta, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a Schmidt, Matthieu |e verfasserin |4 aut | |
| 700 | 1 | |a Brodie, Daniel |e verfasserin |4 aut | |
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| 700 | 1 | |a Luyt, Charles Edouard |e investigator |4 oth | |
| 700 | 1 | |a Lebreton, Guillaume |e investigator |4 oth | |
| 700 | 1 | |a Leprince, Pascal |e investigator |4 oth | |
| 700 | 1 | |a Brechot, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Franchineau, Guillaume |e investigator |4 oth | |
| 700 | 1 | |a Nieszkowska, Ania |e investigator |4 oth | |
| 700 | 1 | |a Hekimian, Guillaume |e investigator |4 oth | |
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| 700 | 1 | |a Abrams, Darryl |e investigator |4 oth | |
| 700 | 1 | |a Parekh, Madhavi |e investigator |4 oth | |
| 700 | 1 | |a Trindade, Anil |e investigator |4 oth | |
| 700 | 1 | |a Kida, Yoshiko |e investigator |4 oth | |
| 700 | 1 | |a Kyo, Michihito |e investigator |4 oth | |
| 700 | 1 | |a Shimatani, Tatsutoshi |e investigator |4 oth | |
| 700 | 1 | |a Shime, Nobuaki |e investigator |4 oth | |
| 700 | 1 | |a Tanigawa, Koichi |e investigator |4 oth | |
| 700 | 1 | |a Valchanov, Kamen |e investigator |4 oth | |
| 700 | 1 | |a Fowles, Jo-Anne |e investigator |4 oth | |
| 700 | 1 | |a Meagher, Louise |e investigator |4 oth | |
| 700 | 1 | |a Papazian, Laurent |e investigator |4 oth | |
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| 700 | 1 | |a Forel, Jean Marie |e investigator |4 oth | |
| 700 | 1 | |a Parke, Rachael |e investigator |4 oth | |
| 700 | 1 | |a McCarthy, Lianne |e investigator |4 oth | |
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| 700 | 1 | |a Pierard, Sophie |e investigator |4 oth | |
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| 700 | 1 | |a Timsit, Jean Francois |e investigator |4 oth | |
| 700 | 1 | |a Sonneville, Romain |e investigator |4 oth | |
| 700 | 1 | |a Dupont, Hervé |e investigator |4 oth | |
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