Is Obesity a Paradox in Extracorporeal Membrane Oxygenation Outcomes? A Case Series

Obesity is an increasingly prevalent global health concern and presents distinct challenges in critical care.While traditionally considered a risk factor for poor outcomes, emerging evidence suggests that obesity may confer a survival benefit in certain populations-a phenomenon referred to as the "obesity paradox." Extracorporeal membrane oxygenation (ECMO) provides life-saving support in patients with refractory cardiac or respiratory failure.However, the role of obesity, particularly class II [body mass index (BMI) 35 kg/m] and morbid obesity (BMI 40 kg/m), in ECMO outcomes is still debated.We present a case series of eight adult patients with class II or higher obesity who received ECMO therapy.Despite anatomical and physiological challenges, favorable outcomes were achieved in several cases.This report examines the technical considerations, outcomes, and implications of ECMO use in obese patients, contributing to the growing discourse on the obesity paradox.