Marefat Meredith, Hashemzadeh Mehrtash, Movahed Mohammad Reza
Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ, USA.
Department of Medicine, University of Arizona, Phoenix, AZ, USA.
J Intensive Care Med. 2025 Jun 27:8850666251351574. doi: 10.1177/08850666251351574.
BackgroundExtracorporeal Membrane Oxygenation (ECMO) is a critical support system for patients with acute and severe cardiac and respiratory failure. This study investigates the impact of different patient body weight categories on the mortality rates of patients undergoing ECMO support.MethodsUsing the Nationwide Sample (NIS) database and ICD-10 codes for 2016 to 2020 in adults over age 18, we evaluated total mortality based on weight categories compared to normal weights using univariate and multivariate analyses.ResultsA total population of 47 990 patients underwent ECMO insertion with a mean age of 52.6 years. Total mortality was 45.7%. Patients with cachexia, overweight, and obesity had similar mortality to normal-weight patients. (Cachexia: 43.75%, normal weight: 46.30%, = .60, OR = 0.90, 95% CI: 0.61-1.33, overweight 42.31%, = .69, OR = 0.85, 95% CI: 0.38-1.89, and obesity 45.73%, = .73, OR = 0.98, 95% CI: 0.85-1.12). However, morbid obesity had the lowest mortality in the univariate analysis (41.89%, = .01, OR = 0.84, 95% CI: 0.73-0.96) but was not significant in the multivariate analysis ( = .66, OR: 0.97, CI: 0.83-1.12). Separating peripheral veno-arterial versus veno-venous ECMO showed similar results with similar mortalities based on weight categories.ConclusionsOur data suggest that the 'obesity paradox' does not exist in ECMO-treated patients, with no effect of weight on total mortality . Further research is necessary to understand the underlying factors contributing to these outcomes.
背景
体外膜肺氧合（ECMO）是急性重症心功能和呼吸功能衰竭患者的关键支持系统。本研究调查了不同体重类别的患者对接受ECMO支持患者死亡率的影响。
方法
使用全国样本（NIS）数据库以及2016年至2020年18岁以上成年人的国际疾病分类第十版（ICD - 10）编码，我们通过单因素和多因素分析，基于体重类别与正常体重相比评估总死亡率。
结果
共有47990例患者接受了ECMO植入，平均年龄为52.6岁。总死亡率为45.7%。恶病质、超重和肥胖患者的死亡率与正常体重患者相似。（恶病质：43.75%，正常体重：46.30%，P = 0.60，OR = 0.90，95%CI：0.61 - 1.33；超重：42.31%，P = 0.69，OR = 0.85，95%CI：0.38 - 1.89；肥胖：45.73%，P = 0.73，OR = 0.98，95%CI：0.85 - 1.12）。然而，病态肥胖在单因素分析中死亡率最低（41.89%，P = 0.01，OR = 0.84，95%CI：0.73 - 0.96），但在多因素分析中无统计学意义（P = 0.66，OR：0.97，CI：0.83 - 1.12）。将外周静脉 - 动脉与静脉 - 静脉ECMO分开分析显示，基于体重类别的死亡率相似，结果类似。
结论
我们的数据表明，在接受ECMO治疗的患者中不存在“肥胖悖论”，体重对总死亡率没有影响。有必要进行进一步研究以了解导致这些结果的潜在因素。
