Childhood Obesity and Extracorporeal Membrane Oxygenation: Special Considerations for Successful Outcomes

Amit Iyengar; Allen Zhu; Jessica Samson; Brian Reemtsen; Reshma Biniwale

doi:10.1055/s-0036-1584681

Childhood Obesity and Extracorporeal Membrane Oxygenation: Special Considerations for Successful Outcomes

J Pediatr Intensive Care. 2017 Jun;6(2):109-116. doi: 10.1055/s-0036-1584681. Epub 2016 Jun 24.

Authors

Amit Iyengar¹, Allen Zhu¹, Jessica Samson², Brian Reemtsen³, Reshma Biniwale³

Affiliations

¹ David Geffen School of Medicine, University of California, Los Angeles, California, United States.
² Department of Perfusion Services, University of California, Los Angeles, California, United States.
³ Department of Cardiothoracic Surgery, Ronald Reagan Medical Center, University of California, Los Angeles, California, United States.

Abstract

The effects of obesity on venoarterial extracorporeal membrane oxygenation (VA-ECMO) outcomes in pediatric population are unknown. We performed retrospective analysis of 41 children (age 2-18 years) undergoing VA-ECMO. The percentage difference between actual body weight and lean body weight, referred to as Δmass, was calculated. Ratios of Δmass to ECMO flow were calculated at 4 and 24 hours. In patients with Δmass:flow ≥ 0.1 at 4 hours, higher 24-hour lactates (20.0 vs. 14.5 mg/dL; p = 0.002) and inotrope scores (17.3 vs. 11.2; p = 0.015) were observed. However, elevated Δmass:flow was not associated with mortality, and in-hospital mortality rates between groups were similar (53 vs. 45%; p = 0.647). In obese pediatric patients requiring VA-ECMO, increased flow is necessary to avoid complications of hypoperfusion and related complications.

Keywords: VA-ECMO; children; obesity.