ECMO Cannulation Criteria in COVID-19 (ECC-VID) and Obesity: A Literature Review and Retrospective Cohort Analysis

Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) continues to be used as rescue therapy for patients with acute respiratory distress syndrome (ARDS) secondary to coronavirus disease 2019 (COVID-19). Although there is emerging literature on the use of and mortality associated with V-V ECMO in the management of patients with COVID-19, our understanding of who may benefit from this management strategy remains limited. Our clinicians sought to provide further insight into pre-cannulation characteristics and mortality in a cohort of patients with COVID-19 associated ARDS managed with V-V ECMO that primarily consisted of obese patients (90%, n=18) with a BMI of 30 kg/m2 or greater. Our findings not only revealed high survival to hospital discharge (70%, n=14) but demonstrated non-inferior outcomes and survival in obese patients. With an imminent next wave of rising infections, knowledge of which patients have a better chance of survival with the initiation of V-V ECMO is essential. Obese patients have been historically underrepresented in ECMO outcomes literature, but our findings suggest the utilization of ECMO for COVID-19 associated ARDS in these patient subsets should be considered and outcomes should be further explored.