Abstract
BackgroundThe effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA).MethodsThis multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (< 18.5 kg/m2), normal weight (≥18.5 to < 25 kg/m2), overweight (≥25 to < 30 kg/m2), and obese groups (≥30 kg/m2) according to the BMI per the World Health Organization (WHO) criteria. The primary outcome was a favourable neurologic outcome; the secondary outcome was survival to discharge. Univariate and multivariate analyses were performed to investigate the association between BMI and outcomes.ResultsNine hospitals were enrolled; finally, 605 patients were included in our analysis and categorised per the WHO BMI classification. Favourable neurologic outcomes were less frequent in the underweight BMI group than in the other groups (p = 0.002); survival to discharge was not significantly different among the BMI groups (p = 0.110). However, the BMI classification was not associated with favourable neurologic outcomes or survival to discharge after adjustment in the multivariate model.ConclusionThe BMI was not independently associated with favourable neurologic and survival outcomes of patients surviving from OHCA.
Highlights
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health
A high body mass index (BMI) is associated with hypertension, type II diabetes mellitus, dyslipidaemia, and major cardiovascular diseases—such as heart failure, coronary heart disease, arrhythmia, and sudden cardiac arrest— resulting in increased risks of both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) [3,4,5,6]
A total of 773 patients who survived to admission after OHCA were eligible; 168 patients were excluded according to the exclusion criteria: 136 were transferred from other hospitals, and 32 had missing data for height, weight, or Cerebral Performance Category (CPC)
Summary
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. A chest compression depth of 5–6 cm is recommended during cardiopulmonary resuscitation to ensure high-quality chest compressions This chest compression depth is insufficient for obese patients who experience cardiac arrest because thorax changes and airway management—including bag-valve mask ventilation—are difficult in such patients considering the changes in their anatomy and distortions [7,8,9,10,11]. The survival and neurologic outcomes of obese patients or patients with a high BMI who experience cardiac arrest are lower than those of other patients [12]. Several previous studies investigated whether being overweight was associated with better survival outcomes in critically ill patients, including the post-resuscitation state, and this phenomenon is called the obesity paradox [13,14,15]. The current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA)
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