title: Veno-venous extracorporeal membrane oxygenation in obese surgical patients with hypercapnic lung failure.
abstract: BACKGROUND
  In patients with a body mass index (BMI) > 35 kg/m(2) , or in extreme cases weighting > 250 kg, we are faced with special challenges in therapy and logistics. The aim was to analyze the feasibility of the extracorporeal membrane oxygenation (ECMO) in these patients.
  
  
  METHODS
  We report 12 adult patients [10 male, 2 female; mean age 56.7 (34-74) years; mean BMI 47.9 (35-88.6) kg/m(2) ] with acute lung failure treated with veno-venous ECMO from 1 January 2009 to 30 June 2013. All patients were cannulated percutaneously into the right internal jugular vein and one of the femoral veins at the bedside.
  
  
  RESULTS
  The mean time to ECMO after admission to the intensive care unit (ICU) was 2 days (0-10), and the mean ECMO run time was 9 days (4 h-20 days). Lung failure occurred in the contexts of wound infection (two patients), anaphylactic shock (one patient), major trauma (one patients) and pneumonia after surgery (four patients), and respiratory failure in abdominal sepsis (four patients). The mean time in the ICU was 31 days (0-89), and the mean time at the hospital was 38 days (0-101). Three patients died on the system because of multiorgan failure; nine patients were weaned from ECMO (75%); and six were patients discharged from the ICU and from the hospital (survival rate 50%).
  
  
  CONCLUSIONS
  ECMO in obese patients is feasible and life saving. Therefore, a percutaneous cannulation remains feasible. The goals of the ECMO therapy include early spontaneous breathing, tracheotomy, rapid reduction of sedation and adequate analgesia. Rehabilitation includes nutritional therapy, as well as psychiatric therapy and bariatric surgery, as perspectives for the future.
authors.affiliation: Department of Surgery, University Hospital Bergmannsheil, Bochum, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Swol
authors.forename: D
authors.initials: D
authors.lastname: Buchwald
authors.forename: M
authors.initials: M
authors.lastname: Dudda
authors.forename: J
authors.initials: J
authors.lastname: Strauch
authors.forename: T A
authors.initials: TA
authors.lastname: Schildhauer
mesh_terms: D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000150:complications; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology* / Q000628:therapy; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007239:Infections / Q000150:complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009765:Obesity / Q000150:complications* / Q000628:therapy; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000097:blood / Q000209:etiology / Q000628:therapy*; D015996:Survival Rate; D014140:Tracheotomy; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives