Obesity survival paradox in pneumonia supported with extracorporeal membrane oxygenation: Analysis of the national registry

Abstract Purpose To investigate whether the obesity survival paradox, where obesity is associated with improved survival, exists for pneumonia supported with extracorporeal membrane oxygenation (ECMO). Materials and methods Between January 2014 and December 2015, 223 patients with acute respiratory failure who underwent ECMO in 11 hospitals in South Korea were enrolled retrospectively, and data relating to pneumonia cases were analyzed. Patients were divided into groups according to their pre-treatment body mass index (BMI): obese (BMI ≥ 25 kg/m 2 ) and non-obese (BMI  2 ). The BMI cut-off was adopted from the World Health Organization for Asian populations. Results In total, 84 patients had pneumonia: obese group, 26; non-obese group, 58 (mean BMI, 27.8 vs. 21.4, p  2 /FiO 2 ratio, low BMI was significantly associated with 6-month mortality (odds ratio 3.28, 95% confidence interval: 1.06–11.03, p = 0.044). Conclusions An obesity survival paradox exists in pneumonia supported with ECMO.