Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest

Babatunde O Ogunnaike; Charles W Whitten; Abu Minhajuddin; Emily Melikman; Girish P Joshi; Tiffany S Moon; Preston M Schneider; Steven M Bradley; American Heart Association's Get With The Guidelines(®)-Resuscitation Investigators

doi:10.1016/j.resuscitation.2016.05.028

Body mass index and outcomes of in-hospital ventricular tachycardia and ventricular fibrillation arrest

Resuscitation. 2016 Aug:105:156-60. doi: 10.1016/j.resuscitation.2016.05.028. Epub 2016 Jun 9.

Authors

Babatunde O Ogunnaike¹, Charles W Whitten², Abu Minhajuddin², Emily Melikman², Girish P Joshi², Tiffany S Moon², Preston M Schneider³, Steven M Bradley³; American Heart Association's Get With The Guidelines(®)-Resuscitation Investigators

Affiliations

¹ University of Texas Southwestern Medical Center, Dallas, TX, United States. Electronic address: Babatunde.Ogunnaike@utsouthwestern.edu.
² University of Texas Southwestern Medical Center, Dallas, TX, United States.
³ VA Eastern Colorado Health Care System and University of Colorado, Denver, CO, United States.

PMID: 27290990
DOI: 10.1016/j.resuscitation.2016.05.028

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<18.5kg/m(2)), normal weight (BMI 18.5-24.9kg/m(2)), over-weight (BMI 25.0-29.9kg/m(2)), obese (BMI 30.0-34.9kg/m(2)), and extremely obese (BMI≥35.0kg/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 24h, 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.

Keywords: Cardiac arrest; First shock success; Index event; Obesity; Resuscitation; Shockable rhythm.

Published by Elsevier Ireland Ltd.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Analysis of Variance
Body Mass Index*
Cardiopulmonary Resuscitation / methods*
Cardiopulmonary Resuscitation / mortality
Defibrillators
Electric Countershock / methods
Electric Countershock / mortality
Female
Heart Arrest / etiology
Heart Arrest / mortality
Heart Arrest / therapy*
Humans
Male
Middle Aged
Registries
Risk Factors
Survival Analysis
Tachycardia, Ventricular / complications
Tachycardia, Ventricular / mortality
Tachycardia, Ventricular / therapy*
Time-to-Treatment
Ventricular Fibrillation / complications
Ventricular Fibrillation / mortality
Ventricular Fibrillation / therapy*