Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest. (August 2016)

• Record Type: Journal Article
• Authors: Ogunnaike, Babatunde O.; Whitten, Charles W.; Minhajuddin, Abu; Melikman, Emily; Joshi, Girish P.; Moon, Tiffany S.; Schneider, Preston M.; Bradley, Steven M.
• Is Part Of: Resuscitation. Volume 105(2016)
• Page Start: 156
• Page End: 160
• Publication Date: 2016-08
• Subjects: Obesity -- Cardiac arrest -- Resuscitation -- Index event -- Shockable rhythm -- First shock success; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2016.05.028
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Background: Due to higher transthoracic impedance, obese patients may be less likely to be successfully defibrillated from ventricular tachycardia or ventricular fibrillation (VT/VF) arrest. However, the association between patient body mass index (BMI), defibrillation success, and survival outcomes of VT/VF arrest are poorly understood. Methods: We evaluated 7110 patients with in-hospital VT/VF arrest at 286 hospitals within the Get With The Guidelines ® -Resuscitation (GWTG-R) Multicenter Observational Registry between 2006 and 2012. Patients were categorized as underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5–24.9 kg/m 2 ), over-weight (BMI 25.0–29.9 kg/m 2 ), obese (BMI 30.0–34.9 kg/m 2 ), and extremely obese (BMI ≥ 35.0 kg/m 2 ). Using generalized linear mixed regression, we determined the risk-adjusted relationship between BMI and patient outcomes while accounting for clustering by hospitals. The primary outcome was successful first shock defibrillation (a post-shock rhythm other than VT/VF) with secondary outcomes of return of spontaneous circulation, survival to 24 h, and survival to discharge. Results: Among adult patients suffering VT/VF arrest, 304 (4.3%) were underweight, 2061 (29.0%) were normal weight, 2139 (30.1%) were overweight, and 2606 (36.6%) were obese or extremely obese. In a risk-adjusted analysis, we observed no interaction between BMI and energy level for the successful termination of VT/VF with first shock. Furthermore, the risk-adjusted likelihood of successful first shock termination of VT/VF did not differ significantly across BMI categories. Finally, when compared to overweight patients, obese patients had similar risk-adjusted likelihood of survival to hospital discharge (odds ratio 0.786, 95% confidence interval 0.593–1.043). Conclusions: There was no significant difference in the likelihood of successful defibrillation with the first shock attempt among different BMI categories.