Effect of Body Mass Index on the Outcome of Surgical Patients Receiving Extracorporeal Devices (VV ECMO,pECLA) for Respiratory Failure

Abstract

Introduction

To determine whether obese surgical patients are at a significant disadvantage in terms of outcomes after extracorporeal device (ECD) support, such as veno-venous extracorporeal membrane oxygenation (VV ECMO) or pumpless extracorporeal lung assist (pECLA), for respiratory failure, the relationship between body mass index (BMI) and hospital outcomes was analyzed.

Methods

This retrospective study included data on patients who were supported with an ECD between January 1, 2008 and December 31, 2014. The analysis included 89 patients (74 male).

Results

The median BMI was 30 kg/m² (19–88.5). The median duration of the ECD support was 9.0 days, with a maximum of 37.1 days. The median LOS (length of stay) in the intensive care unit (ICU) was 21 days (range 0.06–197.6). The median hospital LOS was 34.9 days (range 0.1–213.8). VV ECMO was performed 72 times, and pECLA was performed 18 times. The number of patients successfully weaned off the ECD was 54 (60.6%). Survival at the discharge from the hospital was 48.3%.

Conclusions

54 (60.6%) patients were successfully weaned off the ECD; 43 (48.3%) patients survived and were discharged from the hospital. The analysis of correlations between BMI and outcomes of surgical patients treated with ECD showed no association between BMI and mortality. Complications (especially oxygenator clotting) were not more frequent in obese and extremely obese patients. We hypothesized that patients with higher or morbid BMIs would have increased mortality after ECD support. A BMI of 30.66 kg/m² corresponded to the desired sensitivity and specificity to predict mortality. This finding applied only to the study group. Treatment with ECD in obese patients presents unique challenges, including percutaneous cannulation and increased staff requirements. However, based on these data, obesity should not be an exclusion criterion for ECD therapy.

Keywords

BMI ECMO Outcome pECLA Respiratory failure Surgical patients

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References

World Health Organization (WHO). Overweight and obesity. http://www.who.int/gho/ncd/risk_factors/overweight/en/. Accessed March 15, 2017.

World Health Organization (WHO). Obesity and overweight: factsheetN^°311. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed March 15, 2017.

Chen

, Jiang

, Mao

. Hospital admissions associated with body mass index in Canadian adults. Int J Obes (Lond). 2007; 31(6): 962–967.

Gong

M.N.

, Bajwa

E.K.

, Thompson

B.T.

, Christiani

D.C.

. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax. 2010; 65(1): 44–50.

Dickerson

R.N.

. The obesity paradox in the ICU: real or not? Crit Care. 2013; 17(3): 154.

Tremblay

, Bandi

. Impact of body mass index on outcomes following critical care. Chest. 2003; 123(4): 1202–1207.

Martino

J.L.

, Stapleton

R.D.

, Wang

. Extreme obesity and outcomes in critically ill patients. Chest. 2011; 140(5): 1198–1206.

Akinnusi

M.E.

, Pineda

L.A.

, El Solh

A.A.

. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008; 36(1): 151–158.

Bercault

, Boulain

, Kuteifan

, Wolf

, Runge

, Fleury

J.C.

. Obesity-related excess mortality rate in an adult intensive care unit: A risk-adjusted matched cohort study. Crit Care Med. 2004; 32(4): 998–1003.

10.

Abhyankar

, Leishear

, Callaghan

F.M.

, Demner-Fushman

, McDonald

C.J.

. Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients. Crit Care. 2012; 16(6): R235.

11.

Arabi

Y.M.

, Dara

S.I.

, Tamim

H.M.

. Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Research Group. Clinical characteristics, sepsis interventions and outcomes in the obese patients with septic shock: an international multicenter cohort study. Crit Care. 2013; 17(2): R72.

12.

Fonarow

G.C.

, Srikanthan

, Costanzo

M.R.

, Guillermo

C.B.

, Lopatin

, for the ADHERE scientific advisory committee and investigators. An obesity paradox in acute heart failure: Analysis of body mass index and inhospital mortality for 108927 patients in the Acute Decompensated Heart Failure National Registry. Am Heart J. 2007; 153(1): 74–81.

13.

OBrien

J.M.

Jr. , Phillips

G.S.

, Ali

N.A.

, Lucarelli

, Marsh

C.B.

, Lemeshow

. Body mass index is independently associated with hospital mortality in mechanically ventilated adults with acute lung injury. Crit Care Med. 2006; 34(3): 738–744.

14.

Sakr

, Madl

, Filipescu

. Obesity is associated with increased morbidity but not mortality in critically ill patients. Intensive Care Med. 2008; 34(11): 1999–2009.

15.

Pickkers

, de Keizer

, Dusseljee

, Weerheijm

, van der Hoeven

J.G.

, Peek

. Body mass index is associated with hospital mortality in critically ill patients: an observational cohort study. Crit Care Med. 2013; 41(8): 1878–1883.

16.

Nasraway

S.A.

Jr. , Albert

, Donnelly

A.M.

, Ruthazer

, Shikora

S.A.

, Saltzman

. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med. 2006; 34(4): 964–970, quiz 971.

17.

Yaegashi

, Jean

, Zuriqat

, Noack

, Homel

. Outcome of morbid obesity in the intensive care unit. J Intensive Care Med. 2005; 20(3): 147–154.

18.

Extracorporeal Life Support Organization. ELSO registry. http://www.elso.med.umich.edu/registry.html. Accessed March 15, 2017.

19.

Lim

S.Y.

, Kim

S.I.

, Ryu

Y.J.

, Lee

J.H.

, Chun

E.M.

, Chang

J.H.

. The body mass index as a prognostic factor of critical care. Korean J Intern Med. 2010; 25(2): 162–167.

20.

Kordonowy

L.L.

, Burg

, Lenox

C.C.

. Obesity is associated with neutrophil dysfunction and attenuation of murine acute lung injury. Am J Respir Cell Mol Biol. 2012; 47(1): 120–127.

21.

Stapleton

R.D.

, Dixon

A.E.

, Parsons

P.E.

, Ware

L.B.

, Suratt

B.T.

; NHLBI Acute Respiratory Distress Syndrome Network. The association between BMI and plasma cytokine levels in patients with acute lung injury. Chest. 2010; 138(3): 568–577.

22.

Slynkova

, Mannino

D.M.

, Martin

G.S.

, Morehead

R.S.

, Doherty

D.E.

. The role of body mass index and diabetes in the development of acute organ failure and subsequent mortality in an observational cohort. Crit Care. 2006; 10(5): R137.

23.

Pham

, Combes

, Richard

. Extra-Corporal Membrane Oxygenation (ECMO) For Influenza A(H1N1) Induced Acute Respiratory Distress Syndrome (ARDS): Analysis Of The Factors Associated With Death In 122 French Patients. Am J Respir Crit Care Med. 2012; 185: A6019.

24.

Al-Soufi

, Buscher

, Nguyen

N.D.

, Rycus

, Nair

. Lack of association between body weight and mortality in patients on veno-venous extracorporeal membrane oxygenation. Intensive Care Med. 2013; 39(11): 1995–2002.

25.

Wagner

, Risnes

, Abdelnoor

, Karlsen

H.M.

, Svennevig

J.L.

. Is it possible to predict outcome in pulmonary ECMO? Analysis of pre-operative risk factors. Perfusion. 2008; 23(2): 95–99.

26.

Aubron

, Cheng

A.C.

, Pilcher

. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: a 5-year cohort study. Crit Care. 2013; 17(2): R73.

27.

Beutler

, Schmidt

, Michard

. Hemodynamic monitoring in obese patients: a big issue. Crit Care Med. 2004; 32(9): 1981.

28.

De Jong

, Jung

, Chanques

, Jaber

, Molinari

. Obesity and mortality in critically ill patients: another case of the simpson paradox? Chest. 2012; 141(6): 1637–1638, author reply 1638–1639.

29.

Hall

, Williams

. Recently published papers: bugs, fluids, obesity and food. Crit Care. 2004; 8(3): 148–150.

30.

Frat

J.P.

, Gissot

, Ragot

. Association des Réanimateurs du Centre-Ouest (ARCO) study group. Impact of obesity in mechanically ventilated patients: a prospective study. Intensive Care Med. 2008; 34(11): 1991–1998.

31.