Key result
Higher BMI linked to ~6% higher in-hospital mortality per kg/m2 in non-COVID ARDS on VV ECMO.
Why the study?
Obesity is common in critically ill adults, but its association with outcomes during venovenous extracorporeal membrane oxygenation remains controversial.
Does higher BMI reduce in-hospital mortality in critically ill adults supported with VV ECMO?
Cohort (n=420)
Yes
Does higher BMI reduce in-hospital mortality in critically ill adults supported with VV ECMO?
Odds Ratio: 1.06 (95% CI 1.02–1.1)
p-value: p=0.003
Higher BMI is associated with increased mortality in non-COVID-19 ARDS patients on VV ECMO, providing evidence against an obesity survival paradox in this setting.
Higher BMI was associated with mortality in non-COVID VV ECMO; challenges obesity paradox but leaves open causal effects.
Obesity is common among critically ill adults, but its association with outcomes during venovenous extracorporeal membrane oxygenation (VV ECMO) remains controversial. We evaluated associations of body mass index (BMI) with mortality and Extracorporeal Life Support Organization (ELSO)-defined complications in adults supported with VV ECMO. We conducted a retrospective multicenter cohort study of adults receiving VV ECMO at four centers (2017-2025). The primary outcome was in-hospital mortality; secondary outcomes were ELSO-defined complications. Multivariable logistic regression was adjusted for age, sex, and hospital site; BMI was evaluated as continuous, dichotomized (≥30 vs. <30 kg/m2), and World Health Organization (WHO) obesity class exposures, with interaction testing by coronavirus disease 2019 (COVID-19) status. Among 420 patients (median BMI, 31 kg/m2), in-hospital mortality was 62%. Higher BMI was associated with mortality in non-COVID-19 acute respiratory distress syndrome (ARDS; odds ratio [OR] = 1.06 per 1 kg/m2, 95% confidence interval [CI] = 1.02-1.10, p = 0.003) but not in COVID-19 ARDS (OR = 1.00, 95% CI = 0.94-1.05); there was insufficient evidence of interaction between BMI and COVID-19 (p = 0.07). Higher BMI was associated with renal complications in both groups and infectious complications in non-COVID-19 ARDS (OR = 1.05, 95% CI = 1.02-1.09, p = 0.003). No significant BMI × COVID-19 interaction was detected for any outcomes. These findings do not support an obesity survival paradox during VV ECMO.
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Behaine et al. (2026) conducted a cohort in Acute respiratory distress syndrome requiring VV ECMO (n=420). Body mass index (BMI) vs. Lower BMI was evaluated on In-hospital mortality (OR 1.06 per 1 kg/m2, 95% CI 1.02-1.10, p=0.003). Higher BMI was associated with increased in-hospital mortality in non-COVID-19 ARDS patients on VV ECMO (OR 1.06 per 1 kg/m2; 95% CI 1.02-1.10; p=0.003), with no obesity survival paradox observed.
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