open access
Does obesity influence the return of spontaneous circulation among out-of-hospital cardiac arrest patients? A retrospective cohort study
Affiliations- Department of Anaesthesiology and Intensive Care, University Hospital, Wroclaw, Poland
- Department of Medical Biochemistry, Wroclaw Medical University, Wrocław, Poland
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logroño, Spain
open access
Abstract
INTRODUCTION: Several factors influence spontaneous circulation (ROSC) return in out-of-hospital cardiac
arrest (OHCA) patients, and obesity can be one of them. The aim of this study was to investigate the influence
of obesity on ROSC in patients following OHCA.
MATERIAL AND METHODS: We conducted a retrospective study and analyzed 4,925,214 emergency medical
system (EMS) records. Finally, data from 33,636 OHCA patients in Poland for whom EMS personnel responded
between January 2021 and June 2022 were analyzed.
RESULTS: The univariate analysis showed an association between ROSC and age (p < 0.001, OR: 0.981),
location of the incident (p < 0.001, OR: 1.6), OHCA initial rhythm (p < 0.001, OR: 2.056), obesity (p ≈ 0.003
OR: 1.1.06) and some comorbidities. In the first multivariate model (whole population sample), significant
predictors of ROSC were initial rhythm (Asystole/PEA; p < 0.001; OR: 0.516), age (p < 0.001; OR: 0.986),
location of the incident (p < 0.001; OR: 1.468) and obesity (p = 0.023; OR: 0.924). In the second model
(patients without obesity), the significant predictors (p < 0.001) of ROSC were initial rhythm (Asystole/PEA,
OR: 0.263), public location of the incident (OR: 2.158) and age (OR: 0.986). In the third model (patients with
obesity), the significant predictors of ROSC were initial rhythm (Asystole/PEA, p = 0.002; OR: 0.443), public
location of the incident (p < 0.001; OR: 2.101), age (p < 0.001; OR: 0.981), and stroke (p = 0.005; OR: 2.047).
CONCLUSIONS: In the study population of OHCA patients, obesity significantly predicted the odds of the prehospital
return of spontaneous circulation, reducing the odds by 8.2%. In the overall study population and
the groups of patients with and without obesity, OHCA in public places and ventricular fibrillation/pulsless
ventricular tachycardia (VF/pVT) initiating rhythm were predictors of increased odds of ROSC and older age
reduced these odds.
Abstract
INTRODUCTION: Several factors influence spontaneous circulation (ROSC) return in out-of-hospital cardiac
arrest (OHCA) patients, and obesity can be one of them. The aim of this study was to investigate the influence
of obesity on ROSC in patients following OHCA.
MATERIAL AND METHODS: We conducted a retrospective study and analyzed 4,925,214 emergency medical
system (EMS) records. Finally, data from 33,636 OHCA patients in Poland for whom EMS personnel responded
between January 2021 and June 2022 were analyzed.
RESULTS: The univariate analysis showed an association between ROSC and age (p < 0.001, OR: 0.981),
location of the incident (p < 0.001, OR: 1.6), OHCA initial rhythm (p < 0.001, OR: 2.056), obesity (p ≈ 0.003
OR: 1.1.06) and some comorbidities. In the first multivariate model (whole population sample), significant
predictors of ROSC were initial rhythm (Asystole/PEA; p < 0.001; OR: 0.516), age (p < 0.001; OR: 0.986),
location of the incident (p < 0.001; OR: 1.468) and obesity (p = 0.023; OR: 0.924). In the second model
(patients without obesity), the significant predictors (p < 0.001) of ROSC were initial rhythm (Asystole/PEA,
OR: 0.263), public location of the incident (OR: 2.158) and age (OR: 0.986). In the third model (patients with
obesity), the significant predictors of ROSC were initial rhythm (Asystole/PEA, p = 0.002; OR: 0.443), public
location of the incident (p < 0.001; OR: 2.101), age (p < 0.001; OR: 0.981), and stroke (p = 0.005; OR: 2.047).
CONCLUSIONS: In the study population of OHCA patients, obesity significantly predicted the odds of the prehospital
return of spontaneous circulation, reducing the odds by 8.2%. In the overall study population and
the groups of patients with and without obesity, OHCA in public places and ventricular fibrillation/pulsless
ventricular tachycardia (VF/pVT) initiating rhythm were predictors of increased odds of ROSC and older age
reduced these odds.
Keywords
out-of-hospital cardiac arrest; return of spontaneous circulation; obesity; cardiopulmonary resuscitation
About this articleTitle
Does obesity influence the return of spontaneous circulation among out-of-hospital cardiac arrest patients? A retrospective cohort study
Journal
Disaster and Emergency Medicine Journal
Issue
Article type
Research paper
Pages
42-50
Published online
2023-12-06
Page views
167
Article views/downloads
142
DOI
10.5603/demj.97553
Bibliographic record
Disaster Emerg Med J 2024;9(1):42-50.
Keywords
out-of-hospital cardiac arrest
return of spontaneous circulation
obesity
cardiopulmonary resuscitation
Authors
Piotr Fehler
Lukasz Lewandowski
Izabella Uchmanowicz
Jacek Smereka
Michal Czapla
References (38)- Soar J, Böttiger BW, Carli P, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021; 161(4): 115–151.
- de Graaf C, Donders DNV, Beesems SG, et al. Time to return of spontaneous circulation and survival: when to transport in out-of-hospital cardiac arrest? Prehosp Emerg Care. 2021; 25(2): 171–181.
- Rea T, Kudenchuk PJ, Sayre MR, et al. Out of hospital cardiac arrest: Past, present, and future. Resuscitation. 2021; 165: 101–109.
- Janssen F, Bardoutsos A, Vidra N. Obesity prevalence in the long-term future in 18 european countries and in the USA. Obes Facts. 2020; 13(5): 514–527.
- World Health Organization. Regional Office for Europe. WHO European Regional Obesity Report 2022. World Health Organization. Regional Office for Europe; 2022. https://apps.who.int/iris/handle/10665/353747 (20.07.2023).
- Das S, Debnath M, Das S, et al. Association of overweight and obesity with hypertension, diabetes and comorbidity among adults in Bangladesh: evidence from nationwide Demographic and Health Survey 2017–2018 data. BMJ Open. 2022; 12(7): e052822.
- Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012; 97(7): 2482–2488.
- Yazdi F, Sarabi AG, Monjazebi F, et al. Determination of factors related to emergency re-referral in patients with heart failure a hospital in Tehran — Iran: a cross-sectional study. Disaster Emerg Med J. 2023; 8(2): 71–82.
- Sonmez LO. Cardiovascular physiology and erectile dysfunction. Disaster Emerg Med J. 2022; 7(4): 255–260.
- Chavda MP, Bihari S, Woodman RJ, et al. The impact of obesity on outcomes of patients admitted to intensive care after cardiac arrest. J Crit Care. 2022; 69: 154025.
- Lott C, Truhlár A, Lott C, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021; 161(4): 152–219.
- Plourde B, Sarrazin JF, Nault I, et al. Sudden cardiac death and obesity. Expert Rev Cardiovasc Ther. 2014; 12(9): 1099–1110.
- Di Giacinto I, Guarnera M, Esposito C, et al. Emergencies in obese patients: a narrative review. J Anesth Analg Crit Care. 2021; 1(1): 13.
- Özüçelik D, Doğan S, Çelik S. Comparison of body mass index level by triage level in the emergency department. Disaster Emerg Med J. 2023; 8(1): 10–20.
- Gräsner JT, Meybohm P, Lefering R, et al. ROSC after cardiac arrest--the RACA score to predict outcome after out-of-hospital cardiac arrest. Eur Heart J. 2011; 32(13): 1649–1656.
- Czapla M, Zielińska M, Kubica-Cielińska A, et al. Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study. BMC Cardiovasc Disord. 2020; 20(1): 288.
- Tanaka H, Ong MEH, Siddiqui FJ, et al. Modifiable factors associated with survival after out-of-hospital cardiac arrest in the pan-asian resuscitation outcomes study. Ann Emerg Med. 2018; 71(5): 608–617.e15.
- Havranek S, Fingrova Z, Rob D, et al. Initial rhythm and survival in refractory out-of-hospital cardiac arrest. Post-hoc analysis of the Prague OHCA randomized trial. Resuscitation. 2022; 181: 289–296.
- Haskins B, Nehme Z, Andrew E, et al. One-year quality-of-life outcomes of cardiac arrest survivors by initial defibrillation provider. Heart. 2023; 109(18): 1363–1371.
- Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and cardiovascular disease: a scientific statement from the american heart association. Circulation. 2021; 143(21): e984–e98e1010.
- Gupta T, Kolte D, Mohananey D, et al. Relation of obesity to survival after in-hospital cardiac arrest. Am J Cardiol. 2016; 118(5): 662–667.
- Testori C, Sterz F, Losert H, et al. Cardiac arrest survivors with moderate elevated body mass index may have a better neurological outcome: a cohort study. Resuscitation. 2011; 82(7): 869–873.
- Geri G, Savary G, Legriel S, et al. Influence of body mass index on the prognosis of patients successfully resuscitated from out-of-hospital cardiac arrest treated by therapeutic hypothermia. Resuscitation. 2016; 109: 49–55.
- Wang CH, Chang WT, Huang CH, et al. Associations between body size and outcomes of adult in-hospital cardiac arrest: a retrospective cohort study. Resuscitation. 2018; 130: 67–72.
- Secombe P, Sutherland R, Johnson R. Body mass index and thoracic subcutaneous adipose tissue depth: possible implications for adequacy of chest compressions. BMC Res Notes. 2017; 10(1): 575.
- Evrin T, Szarpak L, Katipoglu B, et al. Video-assisted versus macintosh direct laryngoscopy for intubation of obese patients: a meta-analysis of randomized controlled trials. Disaster Emerg Med J. 2022; 7(1): 30–40.
- Jain R, Nallamothu BK, Chan PS, et al. American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) investigators. Body mass index and survival after in-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2010; 3(5): 490–497.
- Matinrazm S, Ladejobi A, Pasupula DK, et al. Effect of body mass index on survival after sudden cardiac arrest. Clin Cardiol. 2018; 41(1): 46–50.
- Kakavas S, Georgiopoulos G, Oikonomou D, et al. The impact of body mass index on post resuscitation survival after cardiac arrest: A meta-analysis. Clin Nutr ESPEN. 2018; 24: 47–53.
- Carbone S, Canada JM, Billingsley HE, et al. Obesity paradox in cardiovascular disease: where do we stand? Vasc Health Risk Manag. 2019; 15: 89–100.
- Niedziela J, Hudzik B, Niedziela N, et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol. 2014; 29(11): 801–812.
- Bucholz EM, Beckman AL, Krumholz HA, et al. Excess weight and life expectancy after acute myocardial infarction: The obesity paradox reexamined. Am Heart J. 2016; 172: 173–181.
- Carbone S, Lavie CJ, Arena R. Obesity and heart failure: focus on the obesity paradox. Mayo Clin Proc. 2017; 92(2): 266–279.
- Sharma A, Lavie CJ, Borer JS, et al. Meta-analysis of the relation of body mass index to all-cause and cardiovascular mortality and hospitalization in patients with chronic heart failure. Am J Cardiol. 2015; 115(10): 1428–1434.
- Hjalmarsson A, Rawshani A, Råmunddal T, et al. No obesity paradox in out-of-hospital cardiac arrest: data from the Swedish registry of cardiopulmonary resuscitation. Resusc Plus. 2023; 15: 100446.
- Butt JH, Petrie MC, Jhund PS, et al. Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox. Eur Heart J. 2023; 44(13): 1136–1153.
- Corrigendum to: 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2022; 43(42): 4468.
- Fukuda T, Ohashi-Fukuda N, Kondo Y, et al. Epidemiology, risk factors, and outcomes of out-of-hospital cardiac arrest caused by stroke: a population-based study. Medicine (Baltimore). 2016; 95(14): e3107.