Baylor University Medical Center at Dallas, Dallas, TX, USA.
University of North Texas Health Science Center, Fort Worth, TX, USA.
Perfusion. 2024 Oct;39(7):1356-1362. doi: 10.1177/02676591231193269. Epub 2023 Jul 27.
Morbid obesity, as characterized by BMI, is often utilized as an exclusion criterion for VV-ECMO because of presumed poor prognosis and technically complex cannulation. However, the "obesity paradox" suggests obesity may be protective during critical illness, and BMI does not capture variations in body type, adiposity, or fluid balance. This study examines relationships between BMI and patient outcomes. Adult VV-ECMO patients with BMI ≥ 35 kg/m admitted January 2012 to June 2021 were identified from an institutional registry. BMI and outcomes were analyzed with Mann-Whitney U tests and Pearson correlations with Bayesian post-hoc analyses. 116 of 960 ECMO patients met inclusion criteria. Median (Q1, Q3) BMI was 42.3 (37.3, 50.8) and min, max of 35.0, 87.8 with 9.0 (5.0, 15.5) ECMO days. BMI was not significantly correlated with ECMO days (r = -0.102; = .279). Bayesian analyses showed moderate evidence against BMI correlating with ECMO days. In-hospital mortality (27%) was significantly associated with ECMO days ( = .014) but not BMI ( = .485). In this cohort of high-BMI patients, BMI was not associated with survival or time on ECMO. BMI itself should not be used as an exclusion criterion for VV-ECMO.
病态肥胖，以 BMI 为特征，由于预期预后不佳和技术上复杂的插管，通常被用作 VV-ECMO 的排除标准。然而，“肥胖悖论”表明肥胖在危重病期间可能具有保护作用，而 BMI 并不能捕捉到体型、体脂或液体平衡的变化。本研究检查了 BMI 与患者结局之间的关系。从机构登记处确定了 2012 年 1 月至 2021 年 6 月期间 BMI≥35kg/m2 的成人 VV-ECMO 患者。使用 Mann-Whitney U 检验和 Pearson 相关性分析 BMI 和结局，并进行贝叶斯事后分析。960 名 ECMO 患者中有 116 名符合纳入标准。中位数（Q1，Q3）BMI 为 42.3（37.3，50.8），最小值、最大值分别为 35.0、87.8，ECMO 天数为 9.0（5.0，15.5）。BMI 与 ECMO 天数无显著相关性（r=-0.102； =.279）。贝叶斯分析表明，BMI 与 ECMO 天数相关的证据中等。住院死亡率（27%）与 ECMO 天数显著相关（ =.014），与 BMI 无关（ =.485）。在这组高 BMI 患者中，BMI 与生存率或 ECMO 时间无关。BMI 本身不应作为 VV-ECMO 的排除标准。
