Associations of thoracic cage size and configuration with outcomes of adult in-hospital cardiac arrest: A retrospective cohort study

Abstract

To analyse the association of thoracic cage size and configuration with outcomes following in-hospital cardiac arrest (IHCA). A single-centred retrospective study was conducted. Adult patients experiencing IHCA during 2006-2015 were screened. By analysing computed tomography images, we measured thoracic anterior-posterior and transverse diameters, circumference, and both anterior and posterior subcutaneous adipose tissue (SAT) depths at the level of the internipple line (INL). We also recorded the anatomical structure located immediately posterior to the sternum at the INL. A total of 649 patients were included. The median thoracic circumference was 88.6cm. The median anterior and posterior thoracic SAT depths were 0.9 and 1.5cm, respectively. The ascending aorta was found to be the most common retrosternal structure (57.6%) at the INL. Multivariate logistic regression analyses indicated that anterior thoracic SAT depth of 0.8-1.6cm (odds ratio [OR]: 2.98, 95% confidence interval [CI]: 1.40-6.35; p-value=0.005) and thoracic circumference of 83.9-95.0cm (OR: 2.48, 95% CI: 1.16-5.29; p-value=0.02) were positively associated with a favourable neurological outcome while left ventricular outflow track or aortic root beneath sternum at the level of INL was inversely associated with a favourable neurological outcome (OR: 0.37, 95% CI: 0.15-0.91; p-value=0.03). Thoracic circumference and anatomic configuration might be associated with IHCA outcomes. This proof-of-concept study suggested that a one-size-fits-all resuscitation technique might not be suitable. Further investigation is needed to investigate the method of providing personalized resuscitation tailored to patient needs.