Introduction: Obesity, defined as a body mass index ≥ 40 kg/m2, was considered a relative contraindication to cannulation for extra-corporeal membrane oxygenation (ECMO) during the coronavirus pandemic. While body habitus can create technical challenges to cannulation, there is emerging evidence to support that with appropriate patient selection, obesity should not be the sole criteria for exclusion from consideration for ECMO. Here we perform a retrospective propensity score matched (PSM) cohort study examining outcomes in obese compared to non-obese individuals.

Methods: Adults cannulated for ECMO in our institution from 2011 – 2023. Obesity was defined as a BMI ≥ 40 kg/m2 at time of cannulation. Propensity score matching (2:1) was performed using optimal matching on variables: age, sex, Race and ECMO configuration. The outcomes of interest was recovery/transplant and limb complications. Statistics were performed using MatchIt (V4.5.1) in R (V4.2.1).

Results: The matched cohort consisted of 191 obese patients and 382 non-obese patients. After matching, there were no significant differences in age, sex, race, and mode of support (Table 1). When comparing obese to non-obese patients, there were no differences in limb complications (9 [4.7%] 27 [7.1%], p=0.36) and survival to recovery/transplant (100 [52.4%] vs 212 [55.5%], p=0.33).

Conclusion: In appropriately selected populations, clinically meaningful outcomes are comparable between obese and non-obese patients.