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Abstract

Introduction: About 30% of adult population in United States is obese. The outcomes in obese persons in critical illness have been a topic of debate. Some studies showing a protective effect which has been termed as ‘obesity paradox’. Morbidly-obese persons have disadvantage due to their limited cardiopulmonary reserve especially in cardiac arrest. Hypothesis: Obesity predisposes to higher mortality in patients with cardiac arrest. Methods: Using the Nationwide Inpatient Sample 2000-2009, patients older than 18 years, discharged with a diagnosis of cardiac arrest were identified using ICD-9-CM code 427.5. The morbidly-obese (Body mass index?40) were similarly identified using ICD-9-CM code 278.01. Outcome variables included in-hospital mortality, rates of IMV and tracheostomy. Chi square test and Wilcoxon rank-sum test were used to compare variables for unadjusted analysis. Logistic regression model was developed to examine if morbid-obesity was independently associated with mortality. The model was adjusted for demographic and hospital characteristics, insurance status, Charlson’s co-morbidity index and severity of disease as defined by number of organ failures. Results: There were total of 129,3071 estimated adult discharges with cardiac arrest from 2000-2009. Of these, 27,469 (2.1%) were morbidly-obese. Unadjusted in-hospital mortality in patients with cardiac arrest was lower in morbidly-obese when compared to non-obese (63.9% vs. 65.7%, p<0.05). After adjusting for above variables, the odd of mortality were 2.3 times higher (95% confidence interval 1.3-4.1). Morbidly obese persons had higher frequency of invasive mechanical ventilation (63.9% vs. 57.4%, p<0.001)) and tracheostomy (6.6% vs. 4.6%, p< 0.001). Conclusions: Morbid obese persons have 2.2 times higher odds of mortality if they have cardiac arrest when compared to non-morbidly obese. They have higher frequency of prolonged mechanical ventilation and tracheostomy