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Hubble MW, Kaplan GR, Martin M. Influence of patient body weight on the probability of return of spontaneous circulation following out-of-hospital cardiac arrest: an exploratory analysis. Br Paramed J 2024; 9:11-20. [PMID: 39246831 PMCID: PMC11376325 DOI: 10.29045/14784726.2024.9.9.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Introduction In addition to key interventions, including bystander CPR and defibrillation, successful resuscitation of out-of-hospital cardiac arrest (OHCA) is also associated with several patient-level factors, including a shockable presenting rhythm, younger age, Caucasian race and female sex. An additional patient-level factor that may influence outcomes is patient weight, yet this attribute has not been extensively studied within the context of OHCA, despite globally increasing obesity rates. Objective To assess the relationship between patient weight and return of spontaneous circulation (ROSC) during OHCA. Methods This retrospective study included adult patients from a national emergency medical services (EMS) patient record, with witnessed, non-traumatic OHCA prior to EMS arrival from January to December 2020. Logistic regression was used to evaluate the relationship between patient weight and ROSC. Results Complete records were available for 9096 patients, of which 64.3% were males and 25.3% were ethnic minorities. The mean age of the participants was 65.01 years (SD = 15.8), with a mean weight of 93.52 kg (SD = 31.5). Altogether, 81.8% of arrests were of presumed cardiac aetiology and 30.3% presented with a shockable rhythm. Bystander CPR and automated external defibrillator (AED) shock were performed in 30.6% and 7.3% of cases, respectively, and 44.0% experienced ROSC. ROSC was less likely with patient weight >100 kg (OR = 0.709, p <0.001), male sex (OR = 0.782, p <0.001), and increasing age and EMS response time (OR = 0.994 per year, p <0.001 and OR = 0.970 per minute, p <0.001, respectively). Patients with shockable rhythms were more likely to achieve ROSC (OR = 1.790, p <0.001), as were patients receiving bystander CPR (OR = 1.170, p <0.001) and defibrillation prior to EMS arrival (OR = 1.658, p <0.001). Although the mean first adrenaline dose (mg/kg) followed a downward trend due to its non-weight-based dosing scheme, the mean total adrenaline dose administered to achieve ROSC demonstrated an upward linear trend of 0.05 mg for every 5 kg of body weight. Conclusions Patient weight was negatively associated with ROSC and positively associated with the total adrenaline dose required to attain ROSC.
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Affiliation(s)
- Michael W Hubble
- Wake Technical Community College, North Carolina, USA ORCID iD: https://orcid.org/0000-0002-4683-3767
| | - Ginny R Kaplan
- Methodist University, North Carolina, USA ORCID iD: https://orcid.org/0000-0002-5915-4974
| | - Melisa Martin
- Methodist University, North Carolina, USA ORCID iD: https://orcid.org/0009-0006-3648-7780
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Jeong JH, Kim YG, Han KD, Roh SY, Lee HS, Choi YY, Shim J, Choi JI, Kim YH. Association of temporal change in body mass index with sudden cardiac arrest in diabetes mellitus. Cardiovasc Diabetol 2024; 23:46. [PMID: 38281993 PMCID: PMC10823669 DOI: 10.1186/s12933-024-02130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/10/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Underweight imposes significant burden on cardiovascular outcomes in patients with diabetes mellitus. However, less is known about the impact of serial change in body weight status measured as body mass index (BMI) on the risk of sudden cardiac arrest (SCA). This study investigated the association between SCA and temporal change in BMI among patients with diabetes mellitus. METHODS Based on Korean National Health Insurance Service database, participants with diabetes mellitus who underwent health examination between 2009 and 2012 and had prior health examination data (four years ago, 2005-2008) were retrospectively analyzed. BMI was measured at baseline (2005-2008) and 4-year follow-up health examination (2009-2012). Patients were classified in four groups according to the body weight status and its temporal change: sustained non-underweight, sustained underweight, previous underweight, and newly developed underweight. Primary outcome was defined as occurrence of SCA. RESULTS A total of 1,355,746 patients with diabetes mellitus were included for analysis, and SCA occurred in 12,554 cases. SCA was most common in newly developed underweight (incidence rate = 4.45 per 1,000 person-years), followed by sustained underweight (incidence rate = 3.90), previous underweight (incidence rate = 3.03), and sustained non-underweight (incidence rate = 1.34). Adjustment of covariates resulted highest risk of SCA in sustained underweight (adjusted hazard ratio = 2.60, 95% confidence interval [2.25-3.00], sustained non-underweight as a reference), followed by newly developed underweight (2.42, [2.15-2.74]), and previous underweight (2.12, [1.77-2.53]). CONCLUSIONS In diabetes mellitus, sustained underweight as well as decrease in body weight during 4-year follow-up imposes substantial risk on SCA. Recovery from underweight over time had relatively lower, but yet increased risk of SCA. Both underweight and dynamic decrease in BMI can be associated with increased risk of SCA.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Republic of Korea
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Xie W, Zhou J, Zhou H. Impact of Body Mass Index on Cardiac Arrest Outcomes: A Systematic Review and Meta-Analysis. Cardiol Rev 2023:00045415-990000000-00179. [PMID: 38032207 DOI: 10.1097/crd.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The influence of an individual's body mass index (BMI) on cardiac arrest outcomes remains uncertain. The aim of this study is to evaluate the impact of BMI categories (underweight, normal BMI, overweight, and obese) on mortality and neurological outcomes in patients experiencing cardiac arrest. We comprehensively searched standard electronic databases (PubMed, EMBASE, and Scopus) for relevant observational studies published in peer-reviewed journals written in English. We calculated pooled effect estimates using random-effects models and reported them as odds ratios (ORs) with 95% confidence intervals (CIs). We included 20 studies in our meta-analysis. Individuals with normal BMIs and those who were underweight had similar risks of in-hospital mortality (OR, 1.20; 95% CI, 0.90-1.60), mortality within 6 months of discharge (OR, 0.92; 95% CI, 0.59-1.42), mortality after the 1-year follow-up (OR, 2.42; 95% CI, 0.96-6.08), and odds of favorable neurological outcomes at hospital discharge (OR, 0.86; 95% CI, 0.53-1.39) and at the 6-month follow-up (OR, 0.73; 95% CI, 0.47-1.13). The risks of in-hospital mortality and mortality within 6 months of discharge in overweight and obese individuals were similar to those in individuals with normal BMIs. However, overweight (OR, 0.57; 95% CI, 0.35-0.92) and obese individuals (OR, 0.67; 95% CI, 0.51-0.89) had lower risks of mortality after their 1-year follow-ups. For overweight and obese subjects, the reduced risk of mortality after the 1 year of follow-up was noted only for those with in-hospital cardiac arrest and not for those with out-of-hospital cardiac arrest. The odds of favorable neurological outcomes in both overweight and obese individuals were similar to those with normal BMIs. BMI does not significantly impact short-term mortality or neurological outcomes. Overweight and obese individuals appear to have a lower risk of long-term mortality, but this differed by the place of arrest and needs to be confirmed by others.
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Affiliation(s)
- Wangmin Xie
- From the Department of Critical Care Medicine, Huzhou Third Municipal Hospital, the Affiliated Hospital of Huzhou University, Huzhou, Zhejiang Province, China
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Kosmopoulos M, Kalra R, Alexy T, Gaisendrees C, Jaeger D, Chahine J, Voicu S, Tsangaris A, Gutierrez AB, Elliott A, Bartos JA, Yannopoulos D. The Impact Of BMI On Arrest Characteristics and Survival of Patients with Out-Of-Hospital Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation. Resuscitation 2023:109842. [PMID: 37196806 DOI: 10.1016/j.resuscitation.2023.109842] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023]
Abstract
AIM To assess the impact of body mass index (BMI) on survival to hospital discharge of patients presenting with refractory ventricular fibrillation treated with extracorporeal cardiopulmonary resuscitation. We hypothesize that due to limitations in pre-hospital care delivery, people with high BMI have worse survival after prolonged resuscitation and ECPR. METHODS This study is a retrospective single-centre study that included patients suffering refractory VT/VF OHCA from December 2015 to October 2021 and had a BMI calculated at hospital admission. We compared the baseline characteristics and survival between patients with obesity (>30 kg/m2) and those without (≤30kg/m2). RESULTS Two-hundred eighty-three patients were included in this study, and two-hundred twenty-four required mechanical support with veno-arterial extracorporeal cardiopulmonary membrane oxygenation (VA ECMO). Patients with BMI >30 (n = 133) had significantly prolonged CPR duration compared to their peers with BMI ≤30kg/m2 (n = 150) and were significantly more likely to require support with VA ECMO (85.7% vs 73.3%, p = 0.015). Survival to hospital discharge was significantly higher in patients with BMI≤30 kg/m2 (48% vs. 29.3%, p <0.001). BMI was an independent predictor of mortality in a multivariable logistic regression analysis. The four-year mortality rate was low and not significantly different between the two groups (p=0.32). CONCLUSION ECPR yields clinically meaningful long-term survival in patients with BMI>30kg/m2. However, the resuscitation time is significantly prolonged, and the overall survival significantly lower compared to patients with BMI≤30 kg/m2. ECPR should, therefore, not be withheld for this population, but faster transport to an ECMO capable centre is mandated to improve survival to hospital discharge.
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Affiliation(s)
- Marinos Kosmopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Rajat Kalra
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Tamas Alexy
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Christopher Gaisendrees
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; Department of Cardiothoracic Surgery, University Hospital of Cologne, Germany
| | - Deborah Jaeger
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; INSERM U 1116, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Johnny Chahine
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Sebastian Voicu
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States; INSERM UMRS-1144, Lariboisière Hospital, Paris-Diderot University, Paris, France
| | - Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Alejandra B Gutierrez
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Andrea Elliott
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Jason A Bartos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, United States.
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Margolis G, Elbaz-Greener G, Ruskin JN, Roguin A, Amir O, Rozen G. The Impact of Obesity on Sudden Cardiac Death Risk. Curr Cardiol Rep 2022; 24:497-504. [PMID: 35230617 DOI: 10.1007/s11886-022-01671-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We aimed to describe the epidemiology of sudden cardiac death (SCD) in the obese, elaborating on the potential pathophysiological mechanisms linking obesity, SCD, and the outcomes in SCD survivors, as well as looking into the intriguing "obesity paradox" in these patients. RECENT FINDINGS Several studies show increased mortality in patients with BMI > 30 kg/m2 admitted to the hospital following SCD. At the same time, other studies have implied that the "obesity paradox," described in various cardiovascular conditions, applies to patients admitted after SCD, showing lower mortality in the obese compared to normal weight and underweight patients. We found a significant body of evidence to support that while obesity increases the risk for SCD, the outcomes of obese patients post SCD are better. These findings should not be interpreted as supporting weight gain, as it is always better to prevent the "disaster" from happening than to improve your chances of surviving it. Obesity is shown to be significantly associated with increased risk for SCD; however, there is a growing body of evidence, supporting the "obesity paradox" in the survival of SCD victims. Prospectively, well-designed studies are needed to confirm these findings.
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Affiliation(s)
- Gilad Margolis
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Unit, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gabby Elbaz-Greener
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Ariel Roguin
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Unit, Hillel Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Offer Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Guy Rozen
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Unit, Hillel Yaffe Medical Center, Hadera, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel. .,Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA.
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Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
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Lee H, Shin H, Oh J, Lim TH, Kang BS, Kang H, Choi HJ, Kim C, Park JH. Association between Body Mass Index and Outcomes in Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8389. [PMID: 34444142 PMCID: PMC8394455 DOI: 10.3390/ijerph18168389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022]
Abstract
Increased body mass index (BMI) is a risk factor for cardiovascular disease, stroke, and metabolic diseases. A high BMI may affect outcomes of post-cardiac arrest patients, but the association remains debatable. We aimed to determine the association between BMI and outcomes in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library. Studies that included patients who presented ROSC after OHCA, had a recorded BMI, and were assessed for neurological outcomes and in-hospital mortality were included. To assess the risk of bias of each included study, we employed the Risk of Bias Assessment Tool for Non-randomized Studies. We assessed 2427 patients from six studies. Neurological outcomes were significantly poorer in underweight patients (risk ratio (RR) = 1.21; 95% confidence interval (CI) = 1.07-1.37; p = 0.002; I2 = 51%) than in normal-weight patients. Additionally, in-hospital mortality rate was significantly higher in underweight patients (RR = 1.35; 95% CI = 1.14-1.60; p<0.001; I2 = 21%) and in obese patients (RR = 1.25; 95% CI = 1.12-1.39; p<0.001; I2 = 0%) than in normal-weight patients. Poor neurological outcome is associated with underweight, and low survival rate is associated with underweight and obesity in patients with ROSC after OHCA.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Tae-Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Bo-Seung Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Hyuk-Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Changsun Kim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea; (H.L.); (H.S.); (T.-H.L.); (B.-S.K.); (H.K.); (H.-J.C.); (C.K.)
| | - Jung-Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea;
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Chen CT, Lin MC, Lee YJ, Li LH, Chen YJ, Chuanyi Hou P, How CK. Association between body mass index and clinical outcomes in out-of-hospital cardiac arrest survivors treated with targeted temperature management. J Chin Med Assoc 2021; 84:504-509. [PMID: 33742993 DOI: 10.1097/jcma.0000000000000513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the impact of body mass index (BMI) on clinical outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with targeted temperature management (TTM). METHODS We conducted a retrospective cohort study of 261 adult OHCA survivors who received complete TTM between January 2011 and December 2018 using data from the Research Patient Database Registry of Partners HealthCare system in Boston. Patients were categorized as underweight (BMI < 18.5 kg/m2), normal weight (BMI = 18.5-24.9 kg/m2), overweight (BMI = 25-29.9 kg/m2), and obese (BMI ≥ 30 kg/m2), according to the World Health Organization classification. RESULTS The average BMI was 28.9 ± 7.1 kg/m2. Patients with a higher BMI had higher rates of hypertension and diabetes mellitus, and were more likely to be witnessed on collapse. Patients with lower BMI levels had higher sequential organ failure assessment (SOFA) scores, blood urea nitrogen values, and mild thrombocytopenia rates (platelet count <150 K/μL) after the TTM treatment. The survival to discharge and favorable neurological outcome at discharge were reported in 117 (44.8%) and 76 (29.1%) patients, respectively. The survival at discharge, favorable neurologic outcomes at discharge, length of hospital admission, and the occurrence of acute kidney injury did not significantly differ between the BMI subgroups. In logistic regression model, BMI was not an independent predictor for survival at discharge (adjusted odds ratio 0.945, 95% CI 0.883-1.012, p = 0.108) nor for the favorable neurologic outcome at discharge (adjusted odds ratio 1.022, 95% CI 0.955-1.093, p = 0.528). CONCLUSION In OHCA patients treated with TTM, there was no significant difference across BMI subgroups for survival or favorable neurologic outcome at discharge.
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Affiliation(s)
- Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Meng-Chen Lin
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Jing Lee
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Hua Li
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Pathology and Laboratory Medicine Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ying-Ju Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Environmental and Occupational Health Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peter Chuanyi Hou
- Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan, ROC
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Lee H, Oh J, Kang H, Lim TH, Ko BS, Choi HJ, Park SM, Jo YH, Lee JS, Park YS, Yoon YH, Kim SJ, Min YG. Association between the body mass index and outcomes of patients resuscitated from out-of-hospital cardiac arrest: a prospective multicentre registry study. Scand J Trauma Resusc Emerg Med 2021; 29:24. [PMID: 33509251 PMCID: PMC7842019 DOI: 10.1186/s13049-021-00837-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background The effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods This multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (< 18.5 kg/m2), normal weight (≥18.5 to < 25 kg/m2), overweight (≥25 to < 30 kg/m2), and obese groups (≥30 kg/m2) according to the BMI per the World Health Organization (WHO) criteria. The primary outcome was a favourable neurologic outcome; the secondary outcome was survival to discharge. Univariate and multivariate analyses were performed to investigate the association between BMI and outcomes. Results Nine hospitals were enrolled; finally, 605 patients were included in our analysis and categorised per the WHO BMI classification. Favourable neurologic outcomes were less frequent in the underweight BMI group than in the other groups (p = 0.002); survival to discharge was not significantly different among the BMI groups (p = 0.110). However, the BMI classification was not associated with favourable neurologic outcomes or survival to discharge after adjustment in the multivariate model. Conclusion The BMI was not independently associated with favourable neurologic and survival outcomes of patients surviving from OHCA. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00837-x.
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Affiliation(s)
- Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Hyuk Joong Choi
- Department of Emergency Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Suk Lee
- Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Hoon Yoon
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Su Jin Kim
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Obese cardiogenic arrest survivors with significant coronary artery disease had worse in-hospital mortality and neurological outcomes. Sci Rep 2020; 10:18638. [PMID: 33122807 PMCID: PMC7596497 DOI: 10.1038/s41598-020-75752-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
Cardiogenic arrest is the major cause of sudden cardiac arrest (SCA), accounting for 20% of all deaths annually. The association between obesity and outcomes in cardiac arrest survivors is debatable. However, the effect of obesity on the prognosis of patients with significant coronary artery disease (CAD) successfully resuscitated from cardiogenic arrest is unclear. Thus, the association between body mass index (BMI) and outcomes in cardiogenic arrest survivors with significant CAD was investigated. This multicentre retrospective cohort study recruited 201 patients from January 2011 to September 2017. The eligible cardiogenic arrest survivors were non-traumatic adults who had undergone emergency coronary angiography after sustained return of spontaneous circulation and had significant coronary artery stenosis. BMI was used to classify the patients into underweight, normal-weight, overweight, and obese groups (< 18.5, 18.5–24.9, 25.0–29.9, and ≥ 30 kg/m2; n = 9, 87, 72, and 33, respectively). In-hospital mortality and unsatisfactory neurological outcomes (cerebral performance scale scores = 3–5) were compared among the groups. The obese group presented higher in-hospital mortality and unsatisfactory neurological outcome risks than the normal-weight group (in-hospital mortality: adjusted hazard ratio = 4.27, 95% confidence interval (CI) 1.87–12.04, P = 0.008; unsatisfactory neurological outcomes: adjusted odds ratio = 3.33, 95% CI 1.42–8.78, P = 0.009). Subgroup analysis showed significantly higher in-hospital mortality in the obese patients than in the others in each clinical characteristic. In cardiogenic arrest survivors with significant CAD, obesity was associated with high risks of mortality and unsatisfactory neurological recovery.
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Plasma Adipokines in Patients Resuscitated from Cardiac Arrest: Difference of Visfatin between Survivors and Nonsurvivors. DISEASE MARKERS 2020; 2020:9608276. [PMID: 32015774 PMCID: PMC6988666 DOI: 10.1155/2020/9608276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/26/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
Background Adipokines are a group of cytokines or peptides secreted by adipose tissue to exert numerous biological functions. In the present study, we measured the plasma levels of four adipokines (adiponectin, leptin, fatty acid-binding protein 4 (FABP4), and visfatin) in cardiac arrest patients following return of spontaneous circulation (ROSC). Methods Totally, 21 patients who experienced cardiac arrest and successful ROSC with expected survival of at least 48 hours (from January 2016 to December 2017) were consecutively enrolled into this prospective observational clinical study. Of the 21 enrolled patients, ten survived, and other eleven died between 2 days and 6 months post ROSC. Venous blood was drawn at three time points: baseline (<1 hour post ROSC), 2 days post ROSC, and 7 days post ROSC. Plasma concentrations of adiponectin, leptin, FABP4, and visfatin were determined using commercial enzyme-linked immunosorbent assays. Results The plasma visfatin levels at 2 or 7 days post ROSC increased significantly compared with the baseline (P < 0.01), while plasma levels of adiponectin, leptin, and FABP4 did not change. Moreover, plasma visfatin levels in survivors at 2 or 7 days post ROSC were higher than those in nonsurvivors (P < 0.01). Plasma visfatin levels at 2 or 7 days post ROSC were negatively correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score and time to ROSC. Moreover, receiver operating characteristic curve analysis showed that the plasma visfatin levels at 2 or 7 days post ROSC were good predictors for survival of the patients. Conclusion Elevated plasma visfatin levels may be a marker for better outcome of cardiac arrest patients post ROSC.
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Sung CW, Huang CH, Chen WJ, Chang WT, Wang CH, Wu YW, Chen WT, Chang JH, Tsai MS. Obesity is associated with poor prognosis in cardiogenic arrest survivors receiving coronary angiography. J Formos Med Assoc 2019; 119:861-868. [PMID: 31526656 DOI: 10.1016/j.jfma.2019.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/08/2019] [Accepted: 08/29/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The role of body mass index (BMI) in clinical outcomes in patients resuscitated from cardiac arrest (CA) has recently drawn attention. We evaluated the effect of BMI on the prognosis of patients successfully resuscitated from cardiogenic arrest. METHODS This retrospective cohort study included 273 non-traumatic adult cardiogenic arrest survivors receiving coronary angiography after return of spontaneous circulation in three hospitals from January 2011 to September 2017. These patients were classified as underweight, normal-weight, overweight, and obese, based on BMI (<18.5; 18.5-24.9; 25.0-29.9; and ≥30 kg/m2, respectively). In-hospital mortality and poor neurological outcomes were compared among groups. RESULTS The obese group had significantly higher rates of in-hospital mortality and poor neurological outcomes (cerebral performance scale = 3-5) than did the other groups (for underweight, normal-weight, overweight, and obese groups, in-hospital mortality rates were 38.5%, 29.8%, 39.0%, and 64.1%, respectively, p = 0.002; poor neurological outcomes were 53.9%, 43.8%, 47.0%, and 71.8%, respectively, p = 0.02). The obese group exhibited higher risks of in-hospital mortality and poor neurological outcomes than did the normal-weight group (in-hospital mortality: adjusted hazard ratio (aHR) = 5.21, 95% confidence interval (CI) 2.16-10.32, p < 0.001; poor neurological outcomes: aHR = 3.77, 95% CI 1.69-8.36, p = 0.002). CONCLUSION Obesity was associated with higher risks of in-hospital mortality and poor neurological recovery.
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Affiliation(s)
- Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Yen-Wen Wu
- Department of Nuclear Medicine, Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Ting Chen
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan
| | - Jia-How Chang
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Medical College and Hospital, Taipei, Taiwan.
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Liu JZ, Ye S, Cheng T, Han TY, Li Q, Li RX, Zhang Z, Li TY, He YR, Zeng Z, Cao Y. The effects of thoracic cage dimension and chest subcutaneous adipose tissue on outcomes of adults with in-hospital cardiac arrest: A retrospective study. Resuscitation 2019; 141:151-157. [PMID: 31238036 DOI: 10.1016/j.resuscitation.2019.06.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The associations between thoracic cage dimension, chest subcutaneous adipose tissue (SAT) depth and outcomes of adults with in-hospital cardiac arrest (IHCA) remain unknown. METHODS We retrospectively evaluated IHCA patients between January 2016 and October 2017. The thoracic cage transverse diameter, internal AP diameter, cross-sectional area, anterior and posterior SAT depths were measured in computed-tomography (CT) images. Using logistic regression models, we determined the adjusted associations between thoracic cage dimension, SAT depths and the prognosis for IHCA. The primary outcome was sustained return of spontaneous circulation (ROSC) and the secondary outcome was survival to hospital discharge. RESULTS Among 423 IHCA patients, 258 patients achieved ROSC and 70 survived to discharge. Smaller cross-sectional area and posterior SAT depth were significantly related to ROSC. Smaller posterior SAT depth was associated with ROSC. After multivariate adjustment, the smaller cross-sectional area was independently associated with ROSC (Odds ratio [OR] 0.99, 95% confidence interval [95%CI] 0.99-1.00; p = 0.008) and survival to discharge (OR 0.99, 95%CI 0.98-1.00; p = 0.024), and the smaller posterior SAT depth was independently related to ROSC (OR 0.65, 95%CI 0.44-0.96; p = 0.030), whereas no relation to survival to discharge was found. CONCLUSIONS In adults with IHCA, the smaller thoracic cage dimension and posterior SAT depth are associated with better survival. An adjustable compression depth based on the thoracic cage dimension might be better than the "one-size-fits-all" compression depth for resuscitating CA patients. In addition, physicians should pay extra attention to compression efficacy when resuscitating obese patients.
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Affiliation(s)
- Jun-Zhao Liu
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Sheng Ye
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tao Cheng
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tian-Yong Han
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Qin Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Rui-Xin Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Zhuo Zhang
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Tong-Yao Li
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Ya-Rong He
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China
| | - Zhi Zeng
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China.
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, 37 Guoxue Road, Chengdu, Sichuan, China; Disaster Medicine Center, Sichuan University, China.
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Wang CH, Huang CH, Chang WT, Fu CM, Wang HC, Tsai MS, Yu PH, Wu YW, Ma MHM, Chen WJ. Associations between body size and outcomes of adult in-hospital cardiac arrest: A retrospective cohort study. Resuscitation 2018; 130:67-72. [PMID: 29990579 DOI: 10.1016/j.resuscitation.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/19/2018] [Accepted: 07/06/2018] [Indexed: 11/30/2022]
Abstract
AIM Animal studies have demonstrated that hemodynamic-directed cardiopulmonary resuscitation (CPR) improves outcomes following cardiac arrest compared with the "one-size-fits-all" algorithm. We investigated whether body size of patients is correlated with outcomes of in-hospital cardiac arrest (IHCA). METHODS A retrospective study in a single centre was conducted. Adult patients experiencing IHCA between 2006 and 2015 were screened. Body mass index (BMI) was calculated using body weight and height measured at hospital admission. Thoracic anteroposterior diameter (APD) was measured by analysing computed tomography images. Multivariate logistic regression analysis was used to study the associations between independent variables and outcomes. Generalised additive models were used to identify cut-off points for continuous variables. RESULTS A total of 766 patients were included, and 60.4% were male. Their mean age was 62.8 years. Mean BMI was 22.9 kg/m2, and the mean thoracic APD was 21.4 cm. BMI > 23.2 kg/m2 was inversely associated with a favourable neurological outcome (odds ratio [OR]: 0.30, 95% confidence interval [CI]: 0.13-0.68; p-value = 0.004), while thoracic APD was not. When the interaction term was analysed, BMI > 23.2 (kg/m2) × thoracic APD > 18.5 (cm) was inversely associated with both a favourable neurological outcome (OR: 0.33, 95% CI: 0.16-0.69; p-value = 0.003) and survival to hospital discharge (OR: 0.46, 95% CI: 0.26-0.81; p-value = 0.007). CONCLUSION Higher BMI and thoracic APD was correlated with worse outcomes following IHCA. For those patients, it might be better to perform CPR under guidance of physiological parameters rather than a "one-size-fits-all" resuscitation algorithm to improve outcomes.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Ming Fu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ping-Hsun Yu
- Department of Emergency Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Yen-Wen Wu
- Departments of Internal Medicine and Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Nuclear Medicine and Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Ma Y, Huang L, Zhang L, Yu H, Liu B. Association between body mass index and clinical outcomes of patients after cardiac arrest and resuscitation: A meta-analysis. Am J Emerg Med 2018; 36:1270-1279. [DOI: 10.1016/j.ajem.2018.03.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 01/11/2023] Open
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16
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The impact of body mass index on post resuscitation survival after cardiac arrest: A meta-analysis. Clin Nutr ESPEN 2018; 24:47-53. [DOI: 10.1016/j.clnesp.2018.01.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/28/2018] [Indexed: 12/19/2022]
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17
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Obesity was associated with worse neurological outcome among Japanese patients with out-of-hospital cardiac arrest. Intensive Care Med 2018; 44:665-666. [PMID: 29352325 DOI: 10.1007/s00134-017-5042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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18
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Galatianou I, Karlis G, Apostolopoulos A, Intas G, Chalari E, Gulati A, Iacovidou N, Chalkias A, Xanthos T. Body mass index and outcome of out-of-hospital cardiac arrest patients not treated by targeted temperature management. Am J Emerg Med 2017; 35:1247-1251. [DOI: 10.1016/j.ajem.2017.03.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/17/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022] Open
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19
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Gil E, Na SJ, Ryu JA, Lee DS, Chung CR, Cho YH, Jeon K, Sung K, Suh GY, Yang JH. Association of body mass index with clinical outcomes for in-hospital cardiac arrest adult patients following extracorporeal cardiopulmonary resuscitation. PLoS One 2017; 12:e0176143. [PMID: 28423065 PMCID: PMC5397044 DOI: 10.1371/journal.pone.0176143] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/05/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Obesity might be associated with disturbance of cannulation in situation of extracorporeal cardiopulmonary resuscitation (ECPR). However, limited data are available on obesity in the setting of ECPR. Therefore, we investigated the association between body mass index (BMI) and clinical outcome in patients underwent ECPR. METHODS From January 2004 to December 2013, in-hospital cardiac arrest patients who had ECPR were enrolled from a single-center registry. We divided patients into four group according to BMI defined with the WHO classification (underweight, BMI < 18.5, n = 14; normal weight, BMI = 18.5-24.9, n = 118; overweight, BMI = 25.0-29.9, n = 53; obese, BMI ≥ 30, n = 15). The primary outcome was survival to hospital discharge. RESULTS Analysis was carried out for a total of 200 adult patients (39.5% females). Their median BMI was 23.20 (interquartile range, 20.93-25.80). The rate of survival to hospital discharge was 31.0%. There was no significant difference in survival to hospital discharge among the four groups (underweight, 35.7%; normal, 31.4%; overweight, 30.2%; obese, 26.7%, p = 0.958). Neurologic outcomes (p = 0.85) and procedural complications (p = 0.40) were not significantly different among the four groups either. SOFA score, initial arrest rhythm, and CPR to extracorporeal membrane oxygenation (ECMO) pump on time were significant predictors for survival to discharge, but not BMI. CONCLUSION BMI was not associated with in-hospital mortality who underwent ECPR. Neurologic outcomes at discharge or procedural complications following ECPR were not related with BMI either.
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Affiliation(s)
- Eunmi Gil
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae-Sang Lee
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail:
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Jung YH, Lee BK, Lee DH, Lee SM, Cho YS, Jeung KW. The association of body mass index with outcomes and targeted temperature management practice in cardiac arrest survivors. Am J Emerg Med 2017; 35:268-273. [DOI: 10.1016/j.ajem.2016.10.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 01/31/2023] Open
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Improving Measurement of Outcomes in Cardiac Arrest Trials. Pediatr Crit Care Med 2016; 17:1190-1191. [PMID: 27918393 DOI: 10.1097/pcc.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shahreyar M, Dang G, Waqas Bashir M, Kumar G, Hussain J, Ahmad S, Pandey B, Thakur A, Bhandari S, Thandra K, Sra J, Tajik AJ, Jahangir A. Outcomes of In-Hospital Cardiopulmonary Resuscitation in Morbidly Obese Patients. JACC Clin Electrophysiol 2016; 3:174-183. [PMID: 29759391 DOI: 10.1016/j.jacep.2016.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/15/2016] [Accepted: 08/15/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to assess the impact of morbid obesity on outcomes in patients with in-hospital cardiac arrest (IHCA). BACKGROUND Obesity is associated with increased risk of out-of-hospital cardiac arrest; however, little is known about survival of morbidly obese patients with IHCA. METHODS Using the Nationwide Inpatient Sample database from 2001 to 2008, we identified adult patients undergoing resuscitation for IHCA, including those with morbid obesity (body mass index ≥40 kg/m2) by using International Classification of Diseases 9th edition codes and clinical outcomes. Outcomes including in-hospital mortality, length of stay, and discharge dispositions were identified. Logistic regression model was used to examine the independent association of morbid obesity with mortality. RESULTS Of 1,293,071 IHCA cases, 27,469 cases (2.1%) were morbidly obese. The overall mortality was significantly higher for the morbidly obese group than for the nonobese group experiencing in-hospital non-ventricular fibrillation (non-VF) (77% vs. 73%, respectively; p = 0.006) or VF (65% vs. 58%, respectively; p = 0.01) arrest particularly if cardiac arrest happened late (>7 days) after hospitalization. Discharge to home was significantly lower in the morbidly obese group (21% vs. 31%, respectively; p = 0.04). After we adjusted for baseline variables, morbid obesity remained an independent predictor of increased mortality. Other independent predictors of mortality were age and severe sepsis for non-VF and VF group and venous thromboembolism, cirrhosis, stroke, malignancy, and rheumatologic conditions for non-VF group. CONCLUSIONS The overall mortality of morbidly obese patients after IHCA is worse than that for nonobese patients, especially if IHCA occurs after 7 days of hospitalization and survivors are more likely to be transferred to a skilled nursing facility.
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Affiliation(s)
- Muhammad Shahreyar
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Geetanjali Dang
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mohammad Waqas Bashir
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gagan Kumar
- Phoebe Putney Memorial Hospital, Albany, Georgia
| | - Jawad Hussain
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shahryar Ahmad
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beneet Pandey
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Atul Thakur
- Saint Mary's Hospital, Department of General Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sanjay Bhandari
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Krishna Thandra
- Division of Hospital Medicine, Department of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jasbir Sra
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Abdul J Tajik
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin
| | - Arshad Jahangir
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin; Center for Integrative Research on Cardiovascular Aging, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Health Care, Milwaukee, Wisconsin.
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Geri G, Savary G, Legriel S, Dumas F, Merceron S, Varenne O, Livarek B, Richard O, Mira JP, Bedos JP, Empana JP, Cariou A, Grimaldi D. 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. [PMID: 27743918 DOI: 10.1016/j.resuscitation.2016.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/19/2016] [Accepted: 09/05/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obesity prevalence has dramatically increased over recent years and is associated with cardiovascular diseases, but data are lacking on its prognostic impact in out-of-hospital cardiac arrest (OHCA) patients. METHODS Data of all consecutive OHCA patients admitted in two cardiac arrest centers from Paris and suburbs between 2005 and 2012 were prospectively collected. Patients treated by therapeutic hypothermia (TH) were included in the analysis. Logistic and Cox regression analyses were used to quantify the association between body mass index (BMI) at hospital admission and day-30 and 1-year mortality respectively. RESULTS 818 patients were included in the study (median age 60.9 [50.8-72.7] year, 70.2% male). Obese patients (BMI>30kgm-2) were older, more frequently male and evidenced more frequently cardiovascular risk factors than normally (18.5<BMI<25kgm-2) or overweight patients (25<BMI<30kgm-2). Post-resuscitation shock and therapeutic hypothermia failure were more frequent in obese patients. Overall mortality at day-30 and one-year was 63.8 and 67.2%, respectively. After multivariate adjustment, BMI>30kgm-2 was independently associated with day-30 mortality (Odds ratio [OR] in comparison with normally weight patients 2.45; 95% confidence interval [95%CI: 1.32-4.56; p<0.01]). Obesity was not associated with one-year mortality (Hazard ratio [HR] 0.99, 95%CI 0.21,4.67; p=0.99) while underweight was associated with one-year mortality in this subgroup of patients (Hazard ratio [HR] 3.94, 95%CI 1.11,14.01; p=0.03). CONCLUSION In the present study, obesity was independently associated with day-30 mortality in successfully resuscitated ICU TH OHCA patients. Further studies are needed to understand the mechanisms that underpin this finding.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France
| | | | | | - Florence Dumas
- Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France; Emergency Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France
| | | | - Olivier Varenne
- Paris Descartes University, France; Cardiology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France
| | - Bernard Livarek
- Cardiology Department, CH Versailles, Le Chesnay (78), France
| | - Olivier Richard
- Service d'Aide Médicale Urgente (SAMU 78) Department, CH Versailles, Le Chesnay (78), France
| | - Jean-Paul Mira
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France
| | | | - Jean-Philippe Empana
- Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France; Paris Descartes University, France; Sudden Death Expertise Center, Paris Cardiovascular Research Centre, INSERM U970, France
| | - David Grimaldi
- Intensive Care Unit, CH Versailles, Le Chesnay (78), France.
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Gupta T, Kolte D, Mohananey D, Khera S, Goel K, Mondal P, Aronow WS, Jain D, Cooper HA, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Relation of Obesity to Survival After In-Hospital Cardiac Arrest. Am J Cardiol 2016; 118:662-7. [PMID: 27381664 DOI: 10.1016/j.amjcard.2016.06.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/30/2022]
Abstract
Previous studies have shown that obesity is paradoxically associated with improved outcomes in many cardiovascular (CV) disease states; however, whether obesity affects survival after in-hospital cardiac arrest (IHCA) has not been well examined. We queried the 2003 to 2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent cardiopulmonary resuscitation for IHCA. Obese patients were identified using the co-morbidity variable for obesity, as defined in Nationwide Inpatient Sample databases. Survival to hospital discharge was compared between obese and nonobese patients using multivariate regression models. Of 836,289 patients with IHCA, 67,216 (8.0%) were obese. Obese patients were younger and more likely to be women compared with nonobese patients. Despite being younger, obese patients had significantly higher prevalence of most CV co-morbidities such as dyslipidemia, coronary artery disease, previous myocardial infarction, heart failure, diabetes mellitus, hypertension, peripheral vascular disease, and chronic renal failure (p <0.001 for all). Obese patients were more likely to have ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (22.3% vs 20.9%; p <0.001). After multivariate risk adjustment, obese patients had improved survival to hospital discharge compared with nonobese patients (31.4% vs 24.1%; unadjusted odds ratio 1.44, 95% CI 1.42 to 1.47, p <0.001; adjusted odds ratio 1.15, 95% CI 1.13 to 1.17, p <0.001). Similar results were seen in patients with CV or non-CV conditions as the primary diagnosis and in those with ventricular tachycardia/ventricular fibrillation or pulseless electrical activity/asystole as the cardiac arrest rhythm. In conclusion, this large retrospective analysis of a nationwide cohort of patients with IHCA demonstrated higher risk-adjusted odds of survival in obese patients, consistent with an "obesity paradox."
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Dhaval Kolte
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Divyanshu Mohananey
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Sahil Khera
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Kashish Goel
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Pratik Mondal
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York.
| | - Diwakar Jain
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Howard A Cooper
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Sei Iwai
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - William H Frishman
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Julio A Panza
- Division of Cardiology, Department of Medicine, New York Medical College, Valhalla, New York
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26
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 537] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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27
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Abstract
For individuals and the society as a whole, the increased risk of sudden cardiac death in obese patients is becoming a major challenge, especially since obesity prevalence has been increasing steadily around the globe. Traditional risk factors and obesity often coexist. Hypertension, diabetes, obstructive sleep apnea and metabolic syndrome are well-known risk factors for CV disease and are often present in the obese patient. Although the bulk of evidence is circumstantial, sudden cardiac death and obesity share common traditional CV risk factors. Structural, functional and metabolic factors modulate and influence the risk of sudden cardiac death in the obese population. Other risk factors such as left ventricular hypertrophy, increased number of premature ventricular complexes, altered QT interval and reduced heart rate variability are all documented in both obese and sudden cardiac death populations. The present review focuses on out-of-hospital sudden cardiac death and potential mechanisms leading to sudden cardiac death in this population.
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Affiliation(s)
- Benoit Plourde
- Department of Medicine, Faculty of Medicine, Quebec City, QC, Canada
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28
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Leary M, Cinousis MJ, Mikkelsen ME, Gaieski DF, Abella BS, Fuchs BD. The association of body mass index with time to target temperature and outcomes following post-arrest targeted temperature management. Resuscitation 2014; 85:244-7. [DOI: 10.1016/j.resuscitation.2013.10.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/11/2013] [Accepted: 10/24/2013] [Indexed: 10/26/2022]
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29
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