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Morbidly obese patients are considered to be poor candidates for extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure due to COVID-19 pneumonia. A body mass index (BMI) greater than or equal to 40 is a relative contraindication to ECMO by the Extracorporeal Life Support Organization (ELSO) COVID-19 guidelines. This study seeks to determine the impact of obesity on survival of patients with COVID-19 on ECMO. This project is a retrospective cohort study of a multicenter US healthcare system queried from January 2020 to December 2021. All patients aged 16 years and older with COVID-19 treated with ECMO support were included in the study. Patients with missing data on ECMO duration were excluded from secondary analyses. The primary outcome was in-hospital mortality in a time-to-event analysis after ECMO initiation, with a comparison between patient groups based on body mass index (BMI) categories. Secondary outcomes included ventilator days, intensive care days, complications, and discharge destination. We identified 335 patients for the primary analysis; 66 were removed from secondary analysis due to missing data for duration of ECMO. There were no baseline differences between obese and non-obese patients in terms of demographics, comorbidities, pre-ECMO treatments, or hospital length of stay. Obese patients were more likely to be younger (median age 41 vs 45; p = 0.016). Obesity (BMI ≥ 30) was associated with a decreased risk of mortality, odds ratio 0.620 (95% CI 0.399 - 0.964; p = 0.0338) after controlling for age. Severe obesity (BMI ≥ 40) was not associated with increased mortality compared to non-obese. Secondary analysis of 269 patients with complete data demonstrate overall in-hospital mortality of 34.3%. There was no difference in ECMO duration, ICU length of stay, rate of blood stream infection, stroke, or blood transfusion between BMI groups. Obesity is not associated with increased mortality on ECMO for COVID-19. Neither obesity nor severe obesity should be used to rule out candidacy for the use of ECMO in this population. [ABSTRACT FROM AUTHOR]