Obesity and in-hospital Cardiac Arrest

Published Date: 19th July 2016

Publication Authors: Shelton C, Williams A, Kuduvalli P

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Resuscitation of the obese presents numerous challenges. It is known that obesity can affect the airway, ventilation and haemodynamics. At present however, Resuscitation Council (UK) guidelines do not suggest modified Advanced Life Support for the obese patient. A large study based on American Heart Association (AHA) data suggested that obesity does not influence survival; however their comparatively frequent use of invasive airway management may moderate the challenges of resuscitation of the obese. We therefore conducted a pilot study to investigate the outcome of cardiac arrest in our patient population.

Methods

We retrospectively reviewed cardiac arrest audit data from January to November 2010. Intervention and outcome data was recorded on a modified Utstein template. Weight and height were used to calculate body mass index (BMI). In cases where data was not available, documented body habitus was recorded in lieu. Subjects were grouped according to the World Health Organisation classifications of BMI. Statistical analysis was conducted using the chi-squared test.

Results

Eighty-four cardiac arrests were recorded during the study period. BMI data was available for 73 patients; documented body habitus was available for a further four. The remaining patients were excluded. Of our 77 subjects, 13 were underweight, 26 were of normal BMI, 18 were overweight and 20 were obese. Twenty subjects were intubated during resuscitation and 57 ventilated by bag-valve-mask; there was no significant difference in the incidence of intubation between groups. Survival to discharge was greatest in the underweight group (31%), followed by normal BMI (27%), overweight (17%) and obese (10%) however this trend was not statistically significant (p=0.089).

Discussion

The trend towards poor outcome with increased BMI may suggest a discrepancy between outcomes for the obese patient in the UK compared with the AHA group. We hypothesise that early intubation may benefit the obese patient. Further study is required to support a change in practice.

Shelton, C; Williams, A and Kuduvalli, P. (2012).  The effect of obesity on the outcome of in-hospital cardiac arrest . Anaesthesia. 67 (Supplement S1), 40

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