ID:15 FC-D05-2 The Obesity Paradox in Asian Patients with ARDS Requiring ECMO: A Long-term Mortality Analysis

Background: The “obesity paradox” in ARDS is well-documented in Western populations but lacks data in Asian cohorts with different BMI distributions. We investigated the association between BMI and long-term mortality in Korean patients with ARDS requiring extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively analyzed 70 ARDS patients undergoing ECMO (2013–2025). We utilized propensity score adjustment (controlling for age, SOFA, APACHE II, and comorbidities) to assess the impact of BMI on long-term all-cause mortality. Results: Unadjusted mortality decreased progressively with higher BMI (100% in underweight vs. 38.5% in obese). In the propensity score-adjusted model, obesity (BMI ≥25 kg/m2) was significantly associated with reduced long-term mortality risk (Adjusted OR 0.12, 95% CI 0.03–0.50, p=0.003). Probability trend analysis confirmed a linear inverse relationship between BMI and mortality. Subgroup analyses demonstrated consistent benefits of higher BMI in patients <65 years (p=0.02) and those with lower initial SOFA scores (p=0.003). Conclusions: This study confirms the obesity paradox in an Asian ARDS-ECMO cohort. Higher BMI was independent predictor of improved long-term survival, suggesting that nutritional reserve plays a critical protective role in Asian patients undergoing prolonged extracorporeal life support.