Successful Use of Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) for Patients With Morbid Obesity

Abstract

PURPOSE: Morbid obesity is a relative contraindication of extracorporeal membrane oxygenation (ECMO). The safety of placing morbidly obese patients on venovenous (VV) ECMO in is not known. The purpose of this study is to evaluate the outcomes of morbidly obese patients with refractory respiratory failure supported with VV ECMO. METHODS: The records of all adult patients admitted to two tertiary hospitals of the Montefiore Medical Center between June 1, 2009 and March 15, 2013 with refractory respiratory failure requiring ECMO were retrospectively reviewed. Patient characteristics, etiology of respiratory failure, respiratory parameters, cannulation strategy, ECMO duration, ECMO survival, length of stay (LOS) and survival to discharge were examined. All statistical analyses were performed using Stata v11.2. RESULTS: Thirteen consecutive cases of VV ECMO were included in the study. All patients were cannulated via the right IJ and/or femoral approach under transthoracic echo guidance and assistance provided by a trained intensivist or anesthesiologist. The median (IQR) age was 28 (24, 44) years and 46% were men. Eight patients had ARDS, three had status asthmaticus, one had pulmonary edema and one had acute chest syndrome (ACS) from sickle cell crisis. The median (IQR) body mass index was 32 (25, 48). Seven (54%) patients had body mass index (BMI) greater than 30; among them, four were morbidly obese, with a BMI of 48, 54, 56 and 91. All ECMO cannulations were performed at bedside except two morbid obese patients. Overall, the mean+/-SD PF ratio was 49+/-6 in the ARDS group, 48 in the patient with ACS and 67 in the patient with pulmonary edema. The pCO2 was 109, 113 and 148 in the group with status asthmaticus. Comparing patients with and without morbid obesity, the median (IQR) hospital LOS was 39 (25, 51) and 12 (9, 21) days, respectively (p=0.06), and the all-cause in-house mortality was 0 and 33% respectively (p=0.19). CONCLUSIONS: All patients with morbid obesity supported with VV ECMO survived to discharge although the hospital LOS was longer.