Impact of Body Mass Index (BMI) on Outcomes in Veno-Arterial Extracorporeal Membrane Oxygenation

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Abstract Introduction: Obesity is considered a relative contraindication for extracorporeal membrane oxygenation (ECMO) candidacy due to difficulty with cannulation, need for higher cardiac output, and increased morbidity secondary to associated diseases. Our study aims to evaluate the impact of obesity on mortality, with secondary endpoints of hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective study of all patients on veno-arterial (VA) ECMO support at our institution between January 2016 and August 2024. The cohort was categorized into five groups based on BMI: non-obese (< 25 kg/m²), overweight (25 to 29.9 kg/m²), obesity class 1 (30 to 34.9 kg/m²), obesity class 2 (35 to 39.9 kg/m²), obesity class 3 (>= 40 kg/m²). Results: A total of 562 patients underwent VA ECMO. Amongst our cohort 63.9% (359) were male with an average age of 55.8. Diabetes was associated with 21.7% of patients and HTN present in 47% of patients with the highest incidence of both seen in Class III obesity (25.6%, 48.8%). The most common arterial cannula used was 17 Fr with venous being 25 Fr. Median ICU LOS was 13.7 days with longest duration seen in Class I Obesity (17 days). The highest mortality was noted in Class III obesity (60.5%), when adjusted for age, gender and cannula size, mortality was 84.7%. Majority of survivors were discharged to their homes (24.4%). Conclusion: The use of VA ECMO for post cardiogenic shock has progressively increased. High BMI incurs increased morbidity, longer ICU LOS and need for post ICU rehab. BMI should not be considered as a singular exclusion criterion but should induce thoughtful logistical planning to mitigate the potential complications associated with obesity.

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