The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

• Published in: Journal of critical care Vol. 72; p. 154162
• Main Authors: Balik, M., Svobodova, E., Porizka, M., Maly, M., Brestovansky, P., Volny, L., Brozek, T., Bartosova, T., Jurisinova, I., Mevaldova, Z., Misovic, O., Novotny, A., Horejsek, J., Otahal, M., Flaksa, M., Stach, Z., Rulisek, J., Trachta, P., Kolman, J., Sachl, R., Kunstyr, J., Kopecky, P., Romaniv, S., Huptych, M., Svarc, M., Hodkova, G., Fichtl, J., Mlejnsky, F., Grus, T., Belohlavek, J., Lips, M., Blaha, J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2022; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - therapeutic use; Body mass index; Cardiovascular disease; Cor pulmonale; Coronaviruses; Corticosteroids; COVID-19; COVID-19 - therapy; Critical care; Extracorporeal membrane oxygenation; Humans; Hypertension; Hypoxia; Illnesses; Intensive care; Intubation; Medical prognosis; Morbid obesity; Mortality; Obesity; Obesity - complications; Ostomy; Overweight; Pandemics; Patients; Pulmonary embolisms; Respiratory Distress Syndrome - therapy; Retrospective Studies; SARS-CoV-2; SARS-CoV-2 ARDS; Severe acute respiratory syndrome coronavirus 2; Steroids; Ventilators; ECMO; SARS-CoV-2 ARDS; Obesity; APACHE IV; Extracorporeal membrane oxygenation; Corticosteroids; ELSO; Covid-19; ECLS; PEEP; E-CPR ECMO; IPPV; LOS; SOFA; SARS-CoV-2; Morbid obesity; ARDS; BMI
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154162

The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS.
The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed.
292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome.
The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.
•During the pandemic majority of patients with severe ARDS at a high-volume ECMO centre were obese and morbidly obese.•The rates of ECMO were highest among the morbidly obese (BMI˃40).•The obese patients were cannulated on ECMO after a positive PCR test by two days earlier than the non-obese.•The use of ECMO in the obese patients was not associated with worse outcomes – in contrast to the non-obese patients.•ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.