Purpose. Obesity has been associated with an increased risk of respiratory complications and other systemic illnesses. Respiratory dynamics in an obese patient, combined with modified lung physiology of ARDS, present a significant challenge in managing obese patients with ARDS. Many physicians think of obesity as a relative contraindication to ECMO. We performed a meta-analysis to see the effect of obesity on weaning from ECMO and survival to hospital discharge. Methods. We searched online databases for studies on ECMO and obesity. The search yielded 49 citations in total; after extensive review, six studies were assessed and qualified to be included in the final analysis. Patients were stratified into BMI >30 kg/m² (obese) and BMI < 30 kg/m² (nonobese). Results. In meta-analysis, there was a total sample population of 1285 patients, with 466 in the obese group and 819 in the nonobese group. There was no significant difference in weaning from ECMO when compared between obese and nonobese patients, with a risk ratio of 1.03 and 95% confidence interval (CI) of 0.94–1.13 (heterogeneity: chi² = 7.44, df = 4 (), I² = 46%). There was no significant difference in survival rates between obese and nonobese patients who were treated with ECMO during hospitalization, with a risk ratio of 1.04 and 95% CI of 0.86–1.25 (heterogeneity: Tau² 0.03, chi² = 14.61, df = 5 (), I² = 66%). Conclusion. Our findings show no significant difference in survival and weaning from ECMO in obese vs. nonobese patients. ECMO therapy should not be withheld from obese patients, as obesity is not a contraindication to ECMO.

中文翻译：

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肥胖作为 ECMO 脱机失败的风险因素：系统回顾和荟萃分析

目的。肥胖与呼吸系统并发症和其他全身性疾病的风险增加有关。肥胖患者的呼吸动力学与 ARDS 肺生理学的改变相结合，对治疗患有 ARDS 的肥胖患者提出了重大挑战。许多医生认为肥胖是 ECMO 的相对禁忌症。我们进行了一项荟萃分析，以了解肥胖对 ECMO 撤机和出院生存的影响。方法。我们在在线数据库中搜索了有关 ECMO 和肥胖的研究。检索共获得 49 次引用；经过广泛审查，六项研究经过评估并有资格纳入最终分析。患者被分为BMI >30 kg/m ²（肥胖）和BMI < 30 kg/m ²（非肥胖）。结果。在荟萃分析中，总样本人群为 1285 名患者，其中肥胖组 466 名，非肥胖组 819 名。与肥胖和非肥胖患者相比，ECMO 撤机没有显着差异，风险比为 1.03，95% 置信区间 (CI) 为 0.94–1.13（异质性：chi ²  = 7.44，df = 4（）， I ²  = 46%）。住院期间接受 ECMO 治疗的肥胖和非肥胖患者的生存率无显着差异，风险比为 1.04，95% CI 为 0.86–1.25（异质性：Tau ² 0.03，chi ²  = 14.61，df = 5 （）， I ²  = 66%）。结论。我们的研究结果显示，肥胖患者与非肥胖患者的 ECMO 生存率和撤机率没有显着差异。肥胖患者不应停止 ECMO 治疗，因为肥胖并不是 ECMO 的禁忌症。