Abstract 17732: Pulseless Electrical Activity in Middle Age: Is There a Connection to Obesity?

Abstract

Introduction: Sudden cardiac arrest (SCA) presenting with pulseless electrical activity (PEA) has a significantly higher mortality than ventricular fibrillation/tachycardia (VF/VT). Due to the lack of data in middle aged SCA cases, we evaluated predictors of PEA in in this age group. Methods: Out-of-hospital SCA cases were identified from a large ongoing population-based study in a Northwest US metro area (population approx. 1 million), and confirmed by a process of in-house adjudication. Presenting rhythms were identified from review of first responder reports and electrocardiographic recordings. Pearson’s x2 test and independent samples t-test were used for univariate comparisons of middle-aged (35.0-59.9 years) vs. older adults among PEA and VF/VT groups. Logistic regression was used to evaluate significant factors associated with middle-aged vs. older group. Results: A total of 151 middle-aged and 398 older adults presented with PEA. Middle-aged cases were more likely to be male (72.9% vs. 56.0%, p=0.0003), of African American race (14.1% vs. 7.5%, p=0.008), arrest in public locations (22.5% vs. 9.3%, p=0.0004), be unwitnessed (34.4% vs. 23.7%, p=0.02) and have higher survival to hospital discharge (9.3% vs. 4.8%, p=0.05). There was no difference in the response time and bystander CPR (p≥0.11). Middle-aged PEA cases had a lower comorbidity index compared to older PEA (p<0.0001). Obesity was significantly more common among middle-aged compared to older adults in the PEA group (49.0% vs. 35.5%, p=0.02) and remained a significant determinant after multivariable adjustment [OR 1.91 (95% CI 1.14-3.19, p=0.01)]. Among the VF/VT group, the demographic and resuscitation characteristics followed a similar pattern between middle-aged vs. older adults as in the PEA group. However, in the VF/VT group there was no significant difference in the obesity prevalence (p=0.10). Conclusion: Middle-aged cases presenting with PEA were independently associated with obesity. Given the current epidemic of obesity, these findings have significant public health implications and warrant further detailed investigation.