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Obesity can complicate vascular access and predispose patients to comorbid conditions, and being underweight has been linked to poor outcomes in critically ill patients. These factors have led some clinicians to assume that patients at body-mass index (BMI) extremes are more likely to die when undergoing extracorporeal membrane oxygenation (ECMO) than normal-weight patients. However, observational studies have suggested an “obesity paradox,” in which severe obesity appears to be protective in certain cardiopulmonary conditions.
In this U.S. study, researchers evaluated associations between BMI and in-hospital mortality in 48,000 adults who underwent venovenous or venoarterial ECMO. Overall mortality was 46%, and after adjustment for comorbid…