Monday, August 28, 2023
ECMO does not appear to complicate the treatment of acute respiratory failure in obese adults.
A study supported by the National Institutes of Health indicates that adults with… obesity May benefit from using extracorporeal membrane oxygenation (ECMO), an advanced form of breathing support, when in intensive care due to respiratory failure. The use of ECMO was previously questioned in patients with obesity due to the belief that it could complicate treatment. However, the current results, published in American Journal of Respiratory and Critical Care Medicineit was found that patients with obesity who received ECMO were to Acute respiratory distress syndrome (ARDS) had lower mortality rates compared to patients with ARDS without obesity who received ECMO.
In this study, researchers retrospectively reviewed data from 790 patients from more than 20 medical centers in 10 countries who received ECMO to treat acute respiratory distress syndrome (ARDS), a serious lung injury. Among these patients, 320 patients were obese. They found that 24% of patients with obesity died in the intensive care unit, compared to 35% of patients without obesity. The authors were unable to control for all variables within the larger cohort analysis, including disease severity. However, they concluded that the findings support the concept that obesity, which is a risk factor for ARDS, should not be considered in ECMO treatment decisions.
“We hope that clinicians will consider the data from this study when making bedside decisions for ARDS patients with obesity rather than withholding this,” said Daria Rodim, MD, study author, pulmonologist and assistant professor of medicine at NYU Langone. Proactive life-saving treatment. Health, New York City.
Previous studies have found similar results looking at data from patient records and observational reviews. However, this study is the largest to date to evaluate the survival outcome of ECMO among obese adults with acute respiratory distress syndrome (ARDS) based on data from prospective studies and clinical trials, which better reflect real-world clinical outcomes.
ARDS vary in prevalence rate but are responsible for: 10% of admissions to intensive care units around the world. In this study, pneumonia was the most common factor leading to acute respiratory disease. Survival rates for ARDS vary, with about half to three-quarters of patients surviving. Survival rates for ECMO, which is a treatment of last resort, are also variable, but ranged from about 60–75%.
Data for this review came from 440 patients who received intensive care for acute respiratory distress syndrome at hospitals in the United States, France, Australia and Italy between 2012 and 2017. An additional 350 patients came from the Ventilation Management Study of Patients with Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome (LIFEGARDS), which was conducted in 23 intensive care units in 10 countries.
“The findings of this research open up new questions about how obesity may influence critical disease outcomes to guide evidence-based treatment approaches,” he said. James B KellyPhD, director of the Division of Pulmonary Diseases at the National Heart, Lung, and Blood Institute (NHLBI), which funded the study.
This research was supported in part by the NHLBI and the National Center for the Development of Translational Sciences.
About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the worldwide leader in conducting and supporting research in heart, lung, blood, and sleep disorders that advance scientific knowledge, improve public health, and save lives. For more information visit www.nhlbi.nih.gov.
About the National Institutes of Health (NIH):The National Institutes of Health, the country’s medical research agency, includes 27 institutes and centers, and is part of the US Department of Health and Human Services. The National Institutes of Health is the primary federal agency that conducts and supports basic, clinical, and translational medical research, investigating causes and treatments for both common and rare diseases. For more information about the National Institutes of Health and its programs, visit www.nih.gov.
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Rodem D, Fam T, Rackley C, et al. Mortality among patients with obesity and acute respiratory distress syndrome who receive ECMO: the multicentre ECMObesity Study. Am J Respir Crit Care Med. 2023; doi: 10.1164/rccm.202212-2293OC.