Extracorporeal Membrane Oxygenation in Extreme Obesity: A Case Report and Review of the Literature


  • Vitali Azouz Department of Surgery, Summa Akron City Hospital, Akron, OH, USA http://orcid.org/0000-0002-4396-8877
  • Sarah Hill Northeast Ohio Medical Universities, Rootstown, OH
  • Michael Firstenberg Department of Surgery, The Medical Center of Aurora, Aurora CO, USA




The use of extracorporeal membrane oxygenation (ECMO) in the treatment of acute respiratory distress syndrome (ARDS) has been described as early as 1972 [Hill 1972]. Though a subsequent randomized trial showed no survival benefit over conventional mechanical ventilation [Zapol 1979], protective ventilation strategies and evolving extracorporeal technology improvements have led to a resurgence in the use of ECMO for patients with ARDS. The most recent randomized clinical trial, Conventional Ventilation or ECMO for Severe Adult Respiratory Failure (CESAR), showed a significant mortality reduction in ARDS patients who were treated with ECMO [Peek 2009]. The results of the trial have led some to believe that the widespread adoption of ECMO as a feasible treatment for severe respiratory failure is forthcoming [MacLaren 2012; Del Sorbo 2014]. As the use of ECMO continues to increase, clinicians must be aware of the extremes in patient characteristics for which therapy might be considered reasonable. For example, many studies focus on the limited benefit of advanced therapies, such as ECMO, in the elderly [Salna 2014]. However, there is a paucity of literature on using veno-venous extracorporeal membrane oxygenation (VV ECMO) to treat ARDS in patients with extremity obesity [Ull 2015; Belliato 2016; Kadakia 2017]—a population that is often inherently discriminated against with regards to advanced medical and surgical therapies because of the practical challenges of treating someone of great size as well as the inherent social (and professional) biases against such patients. This case demonstrates application of ECMO in a patient with an extreme body mass index (BMI) and confirms the successful use of ECMO in this BMI patient population.


Al-Soufi S, Buscher H, Nguyen ND, Rycus P, Nair P. 2013. Lack of association between body weight and mortality in patients on veno-venous extracorporeal membrane oxygenation. Intensive Care Med 39:1995-2002.

Belliato M, Cremascoli L, Aliberti A, Pagani M, Pellegrini C, Iotti GA. 2016. A case of veno-venous extracorporeal membrane oxygenation for severe respiratory failure in a superobese patient. Clin Case Rep 4:1147-50.

Camboni D, Philipp A, Lubnow M, et al. 2012. Extracorporeal membrane oxygenation by single-vessel access in adults: advantages and limitations. ASAIO J 58:616-21.

Del Sorbo L, Cypel M, Fan E. 2014. Extracorporeal life support for adults with severe acute respiratory failure. Lancet Respir Med 2:154-64.

Fischer AJ, Kaese S, Lebiedz P. 2016. Management of obese patients with respiratory failure – A practical approach to a health care issue of increasing significance. Respir Med 117:174-8.

Gong MN1, Bajwa EK, Thompson BT, Christiani DC. 2010. Body mass index is associated with the development of acute respiratory distress syndrome. Thorax 65:44-50.

Hill JD, O’Brien TG, Murray JJ, et al. 1972. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med. 286:629-34.

Javidfar J, Wang D, Zwischenberger JB, et al. 2011. Insertion of bicaval dual lumen extracorporeal membrane oxygenation catheter with image guidance. ASAIO J 57:203-5.

Kadakia S, Ambur V, Moore R, Toyoda Y, Shiose A. 2017. Venovenous extracorporeal membrane oxygenation in two morbidly obese patients. Gen Thorac Cardiovasc Surg 65(10):594-7.

Kon ZN, Dahi S, Evans CF, et al. 2015. Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support. Ann Thorac Surg 100:1855-60.

Kress JP, Pohlman AS, Alverdy J, Hall JB. 1999. The impact of morbid obesity on oxygen cost of breathing (V˙o 2RESP) at rest. Am J Respir Crit Care Med 160:883-6.

Lazzeri C, Bonizzoli M, Cianchi G, et al. 2017. Body mass index and echocardiography in refractory ARDS treated with veno-venous extracorporeal membrane oxygenation. J Artif Organs 20:50-6.

MacLaren G, Combes A, Bartlett RH. 2012. Contemporary extracorporeal membrane oxygenation for adult respiratory failure: life support in the new era. Intensive Care Med 38:210-20.

Mongero LB, Beck JR, Charette KA, Stewart A. 2006. Respiratory failure of two sp gastric bypass patients and subsequent rescue with extracorporeal membrane oxygenation. Perfusion 21:73-6.

Murray JF, Matthay MA, Luce JM, Flick MR. 1988. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720-3.

Peek GJ, Mugford M, Tiruvoipati R, et al. 2009. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet 374:1351-63.

Salna M, Takeda K, Kurlansky P, et al. 2018. The influence of advanced age on venous–arterial extracorporeal membrane oxygenation outcomes. Eur J Cardiothorac Surg 53:1151-7.

Schmidt M, Tachon G, Devilliers C, et al. 2013. Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults. Intensive Care Med 39:838-46.

Shashaty MG, Stapleton RD. 2014. Physiological and management implications of obesity in critical illness. Ann Am Thorac Soc 11:1286-97.

Swol J, Buchwald D, Strauch JT, Schildhauer TA, Ull C. 2017. Effect of body mass index on the outcome of surgical patients receiving extracorporeal devices (VV ECMO, pECLA) for respiratory failure. Int J Artif Organs 40:102-8.

Ull C, Buchwald D, Strauch J, Schildhauer TA, Swol, J. 2015. Extremely obese patients treated with venovenous ECMO—an intensivist’s challenge. Am J Emerg Med 33:1720.e3-1720.e4.

Zapol WM, Snider MT, Hill JD, et al. 1979. Extracorporeal membrane oxygenation in severe acute respiratory failure: a randomized prospective study. JAMA 242:2193-6.

Yaegashi M, Jean R, Zuriqat M, Noack S, Homel P. 2005. Outcome of morbid obesity in the intensive care unit. J Intensive Care Med 20:147-54



How to Cite

Azouz, V., Hill, S., & Firstenberg, M. (2018). Extracorporeal Membrane Oxygenation in Extreme Obesity: A Case Report and Review of the Literature. The Heart Surgery Forum, 21(6), E485-E488. https://doi.org/10.1532/hsf.2057